scholarly journals Long-Acting Injectable naltrexone for the Management of patients with Opioid Dependence

2011 ◽  
Vol 5 ◽  
pp. SART.S5452 ◽  
Author(s):  
Kimberly L. Kjome ◽  
F. Gerard Moeller
Keyword(s):  
Treatment Adherence ◽  
Opioid Dependence ◽  
Opioid Antagonist ◽  
Published Data ◽  
Remission Maintenance ◽  
Increased Risk ◽  
Oral Naltrexone ◽  
Poor Treatment ◽  
Naltrexone Treatment ◽  
Long Acting

Opioid dependence is a condition with serious clinical ramifications. Treatment has focused on detoxification, agonist therapy with methadone or buprenorphine, or remission maintenance with the opioid antagonist, naltrexone. Treatment with oral naltrexone has been limited by poor treatment adherence and relapse. Studies with long-acting formulations have shown increased treatment adherence. Extended-release injectable naltrexone has been used for the treatment of alcohol dependence, and has recently received an indication for treatment of opioid dependence from the US Food and Drug Administration. Dosing occurs once monthly and existing data with long-acting naltrexone supports efficacy of treatment for opioid dependence; however published data is sparse. Treatment with long-acting naltrexone should be monitored for hepatotoxicity, and patients should be made aware of increased risk of overdose with administration of opioids during and immediately after discontinuation of long-acting naltrexone.

scholarly journals Use of Oral and Implantable Naltrexone in the Management of the Opioid-Impaired Physician

2003 ◽  
Vol 31 (2) ◽  
pp. 196-201 ◽  
Author(s):  
G. K. Hulse ◽  
G. O'Neil ◽  
M. Hatton ◽  
M. J. Paech
Keyword(s):  
Previous Treatment ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Medical Board ◽  
Prescription Drug Use ◽  
Increased Risk ◽  
Oral Naltrexone ◽  
Patients At Risk ◽  
Ongoing Monitoring

Doctors are at an increased risk for prescription drug use, particularly opioids and benzodiazpines. This use can interfere with work function and has major potential negative implications for patient safety. Oral naltrexone, an opioid antagonist, has been used as part of a management strategy for opioid-dependent physicians. While some patients stabilize on oral naltrexone, others relapse to opioid use. An alternative method of naltrexone maintenance involves the injection or surgical insertion of a sustained release preparation of naltrexone. This approach dramatically improves compliance, removing the onus from the previously opioid impaired physician to use daily oral naltrexone. This article describes the cases of four opioid-impaired doctors who received naltrexone (either oral or implant) as part of their management. The authors conclude that monitoring daily oral naltrexone use and detecting early opioid relapse is difficult, placing both the opioid impaired physician and their patients at risk. In contrast, by using implantable naltrexone, compliance is assured and opioid abstinence can virtually be guaranteed for five months. It is argued that naltrexone implants offer a level of protection not achieved with any previous treatment. It is recommended that management should involve early and close collaboration between the treating doctor and the Medical Board, with initial treatment, ongoing monitoring and follow-up being a Medical Board requirement for registration.

Strategies for optimizing medication adherence in schizophrenia

CNS Spectrums ◽  
2012 ◽  
Vol 17 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Debbi A. Morrissette ◽  
Andrew J. Cutler
Keyword(s):  
Treatment Adherence ◽  
Cognitive Deficits ◽  
Treatment Team ◽  
Adverse Side Effects ◽  
Increased Risk ◽  
Medication Selection ◽  
Medication Efficacy ◽  
Dosing Strategy ◽  
Long Acting ◽  
Psychosocial Approaches

Medication nonadherence is a common problem in the treatment of schizophrenia. The consequences of nonadherence are numerous and can be quite serious, including increased risk of rehospitalization and suicide. There are numerous factors that affect a patient's decision and ability to take medication, including medication efficacy and tolerability, treatment regimen, cognitive deficits, and the patient's relationship with the treatment team. Fortunately, there are several strategies that may increase treatment adherence, including individualization of medication selection and dosing strategy to maximize efficacy and minimize adverse side effects, utilization of long-acting injectable depot formulations that eliminate the need for the patient to remember daily oral medication, and psychosocial approaches that emphasize the benefits of staying well.

Pharmacogenetics of treatment of opioid dependence with oral naltrexone and long-acting sustained-release naltrexone implant

2015 ◽  
Vol 146 ◽  
pp. e165
Author(s):  
E. Krupitsky ◽  
A. Kibitov ◽  
E. Zvartau ◽  
E. Blokhina ◽  
E. Verbitskaya ◽  
...  
Keyword(s):  
Sustained Release ◽  
Opioid Dependence ◽  
Oral Naltrexone ◽  
Long Acting

P.6.d.004 Pharmacogenetics of treatment of opioid dependence with oral naltrexone and long acting sustained release naltrexone implant

2013 ◽  
Vol 23 ◽  
pp. S575-S576
Author(s):  
E. Krupitsky ◽  
E. Zvartau ◽  
E. Blokhina ◽  
D. Nielsen ◽  
T. Kosten ◽  
...  
Keyword(s):  
Sustained Release ◽  
Opioid Dependence ◽  
Oral Naltrexone ◽  
Long Acting

scholarly journals NALTREXONE ASSOCIATED SEIZURE: A CASE REPORT

2021 ◽  
pp. 1-2
Author(s):  
Rajdip Barman ◽  
Pradipta Majumder ◽  
Varun Sharma
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Oral Naltrexone ◽  
Rare Side Effect ◽  
Gastrointestinal Side Effects ◽  
Long Acting

Naltrexone is an opioid antagonist prescribed to treat opioid use disorder and as an anti-craving medication for alcohol use disorder. Gastrointestinal side effects are considered the most common, and liver damage is a serious and rare side effect of naltrexone. In this case report, we describe a 40-year-old patient who developed a seizure after initiating treatment with naltrexone. Although the mechanism is not clear as naltrexone is not a well-known pro-convulsant medication, a few hypotheses for association with seizure have been postulated based on the studies on opioid agonists and similar opioid antagonist naloxone. Based on this case report, we strongly recommend that clinicians should thoroughly assess the risk factors for seizures in patients before using naltrexone and start long-acting injectable naltrexone only after an adequate trial of oral naltrexone to minimize the risk of seizure.

scholarly journals Exploring genetic predictors of naltrexone treatment response in opioid use disorder

2019 ◽  
pp. 61-64
Author(s):  
Е. A. Blokhina . ◽  
E. М. Krupitsky ◽  
А. O. Kibitov ◽  
V. Ya. Palatkin ◽  
T. S. Yaroslavtseva ◽  
...  
Keyword(s):  
Genetic Analysis ◽  
Treatment Outcomes ◽  
Opioid Receptor ◽  
Treatment Program ◽  
Opioid Dependence ◽  
Kappa Opioid Receptor ◽  
Controlled Clinical Trial ◽  
Opioid Use ◽  
Oral Naltrexone ◽  
Naltrexone Treatment

Purpose: The present study was aimed to evaluate the effect of the opioid receptors genes and dopamine system genes polymorphisms on the treatment outcomes of opioid dependence with implantable and oral naltrexone in randomized double blinded double dummy placebo controlled clinical trial. Methods: 306 patients with opioid dependence were randomized in 3 treatment groups (102 ss in each). The first group received implantation of 1000 mg naltrexone every 2 months during the 6 months period + oral naltrexone placebo; the second group — placebo implant every 2 months + oral naltrexone (50mg/day), and the third group — placebo implant + oral naltrexone placebo. All enrolled participants provided blood sample at baseline for genetic analysis of polymorphisms in following genes: mu-opioid receptor (OPRM1), kappa-opioid receptor (OPRK1), catechol-O-methyltransferase (COMT), dopamine receptors types 2 (DRD2) and 4 (DRD4), dopamine-beta-hydroxylase, and dopamine transporter (DAT1). Results: Regardless of provided treatment several polymorphisms of tested genes were associated with high risk of relapse: allele L (2R) DRD4 120bp (p=0.05; OR(95% CI)=3.3(1.1-10.1) ); allele С DRD2 NcoI (р=0,051 OR(95% CI) = 2,86 (1,09 — 7,52); genotype 9.9 DAT VNTR40bp (р=0,04; RR(95% CI) = 1,4(1,3 — 1,5)); on the contrary variants of polymorphisms (СС+СТ)-(ТТ)) of genes (OPRK1- DRD2Ncol) increased the chance to complete the treatment program (р=0,004; OR(95% CI) = 7.4 (1.8 — 30.4)), Kaplan-Meier survival analysis, р=0,016). The probability of completing treatment program by carriers of all these above mentioned variants of polymorphisms (OPRK1DRD2Ncol) was higher for oral naltrexone group (p=0.016), lower for double placebo group (p=0.015), but did not influence treatment outcomes in naltrexone-implant group. Conclusion: Naltrexone-implant is an effective medication for treatment of opioid dependence and its effectiveness exceeds oral naltrexone and placebo. The study showed joint influence of opioid receptor genes and genes of dopaminergic system on the treatment outcomes of opioid dependence. Genetic analysis is useful for determining potential responders to naltrexone treatment of opioid dependence.

scholarly journals Randomized Trial of Long-Acting Sustained-Release Naltrexone Implant vs Oral Naltrexone or Placebo for Preventing Relapse to Opioid Dependence

2012 ◽  
Vol 69 (9) ◽  
pp. 973 ◽  
Author(s):  
Evgeny Krupitsky ◽  
Edwin Zvartau ◽  
Elena Blokhina ◽  
Elena Verbitskaya ◽  
Valentina Wahlgren ◽  
...  
Keyword(s):  
Sustained Release ◽  
Randomized Trial ◽  
Opioid Dependence ◽  
Oral Naltrexone ◽  
Long Acting

scholarly journals Use of Psychoeducation for Psychotic Disorder Patients Treated With Modern, Long-Acting, Injected Antipsychotics

2021 ◽  
Vol 12 ◽  
Author(s):  
Antonio Ventriglio ◽  
Annamaria Petito ◽  
João Maurício Castaldelli-Maia ◽  
Julio Torales ◽  
Valeria Sannicandro ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Psychotic Disorder ◽  
Negative Symptoms ◽  
Second Generation ◽  
Psychotic Disorders ◽  
Metabolic Effects ◽  
Psychotic Symptoms ◽  
Increased Risk ◽  
Second Generation Antipsychotics ◽  
Long Acting

Introduction: There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk. We now report on clinical and metabolic outcomes in patient-subjects diagnosed with affective and non-affective psychotic disorders following exposure to psychoeducation on metabolic risks of modern antipsychotics followed by treatment with long-acting atypical injected antipsychotics over 6-months.Materials and Methods: 85 psychotic disorder outpatients (42 affective [AP]; 43 non-affective [NAP]) at the University of Foggia were treated with long-acting, injected, second-generation antipsychotics in association with a set of psychoeducational sessions concerning general health and potential effects of antipsychotic drug treatments. They were evaluated at baseline and six months.Results: Initially, NAP subjects reported higher ratings of positive and negative symptoms than AP subjects, were more likely to receive risperidone or paliperidone, with higher CPZ-eq doses of antipsychotics (294.0 ± 77.8 vs. 229.3 ± 95.8 mg/day), and shorter QTc electrocardiographic recovery intervals. During the 6-month follow-up, ratings of treatment-adherence improved through overall (+8.75%), and symptom-ratings decreased (−7.57%) as did Body-Mass Index (−2.40%; all p ≤ 0.001). Moreover, serum levels of fasting glucose, hemoglobin glycosylation, cholesterol and prolactin concentrations all decreased, with little difference between subjects with AP vs. NAP.Discussion and Conclusions: A psychoeducational program was associated with consistent improvement in psychotic symptoms and several metabolic and physiological measures, as well as with treatment-adherence during six months of treatment with long-acting, injected, second-generation antipsychotics, in association with both affective and non-affective psychotic disorders.

scholarly journals Naltrexone Treatment for Prolonged Grief Disorder: Study Protocol for a Randomized, Triple-Blinded, Placebo-Controlled Trial

2020 ◽  
Author(s):  
James Gang ◽  
James Kocsis ◽  
Jonathan Avery ◽  
Paul Maciejewski ◽  
Holly Prigerson
Keyword(s):  
Symptom Severity ◽  
Pharmacological Treatment ◽  
Controlled Trial ◽  
Prolonged Grief Disorder ◽  
Prolonged Grief ◽  
Increased Risk ◽  
Oral Naltrexone ◽  
Naltrexone Treatment ◽  
Reward Pathway

Abstract BACKGROUNDThere is a lack of effective pharmacotherapy for prolonged grief disorder (PGD). Evidence suggests that the neurobiology of PGD involves the same circuitry as the reward pathway. Based upon this evidence, we hypothesize that PGD can be conceptualized as a disorder of addiction, and therefore could benefit from being treated with medications that are currently used to treat such disorders. One such medication is naltrexone, which is currently used to treat alcohol and opioid dependence. Oral naltrexone was chosen for its mechanism of action, safety, and convenience. The primary aim of this study is to establish the efficacy of using oral naltrexone as a pharmacological treatment for PGD. Specifically, we hypothesize that participants receiving naltrexone will demonstrate reduced PGD symptoms when compared to placebo.METHODS/DESIGNThis is a randomized, placebo-controlled, triple-blinded (to healthcare professionals, participants, and data analysts) in which we propose to enroll 46 participants who meet criteria for Prolonged Grief Disorder (PGD). Participants will be randomly assigned to the naltrexone 50 mg oral arm or placebo arm; medications will be over-encapsulated to appear identical. Participants will take their assigned medication for 8 weeks, with monthly clinic visits to assess symptom severity, social closeness, and adverse reactions. Weekly surveys of Prolonged Grief-13-Revised (PG-13-R) will be used to relate naltrexone use to changes in PGD symptom severity. Follow-up 4 weeks after their last visit will assess the longevity of treatment, as well as any lingering adverse reactions.DISCUSSIONThis study is the first to investigate the use of oral naltrexone as pharmacological treatment for PGD. The acute and debilitating nature of the disorder, in addition to the evidence demonstrating the increased risk of comorbidities, highlights the need for pharmacological treatment like naltrexone that can act more rapidly, may help those for whom psychotherapy may not be effective, and/or may augment psychotherapy to promote PGD symptom grief resolution.TRIAL REGISTRATIONClinicalTrials.gov, NCT04547985. Registered on 8/31/2020, https://clinicaltrials.gov/ct2/show/NCT04547985.

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