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Naltrexone hydrochloride is a drug prescribed to help people maintain abstinence after they have withdrawn (detoxified) from heroin or other opioids. It is also used in an experimental treatment to bring about rapid withdrawal from opioids. Naltrexone has also been used as a treatment to support abstinence for people who are dependent on alcohol. Followup liver function tests After the initial screening, followup LFTs (Liver function tests) should be completed after 1 month of naltrexone treatment. If the results are acceptable, followup LFTs may then be conducted at 3 and 6 months after the initiation of treatment, depending on the severity of liver dysfunction at the start of treatment. More frequent monitoring is indicated for cases in which dose adjustments are being made, baseline LFTs are high, there is a history of hepatic disease, disulfiram or other potential hepatic-toxic medication is added to the treatment, or symptomatology indicates the need for monitoring. Pain management Because naltrexone blocks the effects of usual doses of therapeutic opioids, providers should use nonnarcotic methods of analgesia as first line of treatment for pain conditions. If narcotic pain relief is indicated, patients must discontinue naltrexone use for the period during which analgesics are required. If a painful event such as surgery is anticipated, then naltrexone should be discontinued 72 hours prior to the procedure. If a patient is taken off naltrexone and put on an opioid analgesic, he or she should be abstinent from the narcotic for at least 3 to 5 days before resuming naltrexone treatment. In emergencies such as cases of acute severe pain, higher doses of opioid analgesics may be used with extreme caution to override the blockade produced by naltrexone. The narcotic dose needs to be carefully titrated to achieve adequate pain relief without oversedation or respiratory suppression. Both the dose and the patient's vital signs (including respiratory rate, level of awareness, and level of analgesia) must be closely monitored. Respiratory assistance and support must be available, should this be necessary. Continued drinking The continued or periodic drinking of alcohol may not be a sufficient reason to discontinue naltrexone: Some patients respond to naltrexone treatment at first by reducing rather than stopping their drinking. When a patient drinks during treatment, the treatment provider should evaluate whether the patient is taking his or her medication regularly and actively participating in treatment. The intensity of care along with the expectations placed on the patient may be increased. Dose adjustments may also be indicated. Abstinence should be a desired goal for the patient; however, reductions in drinking may be an acceptable intermediate outcome. Failure to maintain complete abstinence is not necessarily a failure of treatment because there are many other areas of a patient's life that can improve, such as job performance, social relationships, and general physical health. Use of naltrexone in conjunction with disulfiram The concomitant use of two potentially hepatotoxic medications is not ordinarily recommended unless the probable benefits outweigh the known risks. If naltrexone is used with disulfiram, then treatment providers should perform LFTs (Liver function tests) shortly after the initiation of combined use. Providers should retest patients every 2 weeks for 1 to 2 months and thereafter at regular intervals, such as monthly. Combination therapy with disulfiram and naltrexone should not be used for very long periods, and generally, the two drugs should not be started simultaneously. |
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