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Naltrexone hydrochloride - HCL is used to help narcotic addicts who have stopped taking narcotics to stay drug-free. It is also used to help alcoholics stay alcohol-free. The medicine is not a cure for addiction. It is used as part of an overall program that may include counseling, attending support group meetings, and other treatment recommended by your doctor.
Naltrexone interactions with opiates and opioids
Because naltrexone may cause or worsen opiate withdrawal in subjects who are physiologically dependent on opiates or who are in active opiate withdrawal, it is contraindicated in these patients until after they have been abstinent from opiates for at least 5 to 10 days, or longer if they are withdrawing from methadone without benefit of buprenorphine (Buprenex). Naltrexone is absolutely contraindicated in patients currently maintained on methadone or LAAM (levo-alpha-acetyl-methadol) for the treatment of opiate dependence. Naltrexone does not interfere with nonopioid pain medications such as ibuprofen, acetaminophen, and aspirin.
If at any time the need for opioid treatment becomes necessary, naltrexone therapy can be discontinued for 2 or 3 days, and the opioid can then be given in conventional doses. If opioids are needed to reduce pain in someone with recent naltrexone ingestion, pain relief can still be obtained but at higher than usual doses. These doses require close medical monitoring.
Patients should be warned that self-administration of high doses of opiates while on naltrexone is extremely dangerous and can lead to death from opioid intoxication by causing respiratory arrest, coma, or circulatory collapse. In emergency situations requiring opiate analgesia, a rapidly acting analgesic with minimal respiratory depression should be used and carefully titrated to the patient's responses.
Naltrexone interactions with other drugs
Caution should be used when combining naltrexone with other drugs associated with potential liver toxicity, such as acetaminophen and disulfiram (Antabuse). Other interactions of which are aware include thioridazine (Mellaril) and oral hypoglycemics. The recommendation is that clinicians be aware of all of the patient's medications and watch closely for naltrexone's interactions with other drugs. Concurrent use of antidepressants and naltrexone appears to be safe.
Naltrexone interaction with alcohol
Unlike disulfiram, naltrexone does not appear to alter the absorption or metabolism of alcohol and does not have major adverse effects when combined with alcohol. Some patients, however, have noted increased nausea caused by drinking alcohol while taking naltrexone. Patients on naltrexone are less likely to relapse to heavy drinking following a lapse in abstinence. However, both patient and provider should know that naltrexone does not make people "sober up" and does not alter alcohol's acute effects on cognitive functioning.
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