Naltrexone XR: When & How to Initiate?

Naltrexone XR is an opioid antagonist, which is FDA approved for opioid use disorder. The main benefits of naltrexone-XR are:

  • extended duration of its action protecting individuals from relapse for a month
  • avoiding non-adherence risk of daily medication compliance.
  • improved treatment retention.
  • effectiveness of XR-naltrexone is comparable to buprenorphine.

NALTREXONE XR: WHEN & HOW TO INITIATE?

Let’s begin by answering this question first:

Naltrexone XR(Q): 32-year-old male with a history of opioid use disorder is interested in naltrexone XR once a month injection. Which of the following is the correct indication of initiating Naltrexone XR now for him?

WATCH THE FOLLOWING 5 MIN VIDEO DISCUSSION TO FIND YOUR ANSWER:

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Watch the following academy chapter summarizing this clinically relevant topic in the following five sections:

WATCH ACADEMY CHAPTER:

This chapter will be discussed in the following sections: 

  1. Assessment: before initiation of Naltrexone XR
  2. Clinical Opiate Withdrawal Scale (COWS)
  3. Naltrexone (oral) challenge test
  4. Naloxone (i.m) challenge test
  5. When NOT to prescribe Naltrexone XR: Contraindications.

References:

  1. Am J Drug Alcohol Abuse. 2020 May 3; 46(3): 289–296.
  2. Lancet. 2011 Apr 30; 377(9776):1506-13.
  3. JAMA Psychiatry. 2017 Dec 1; 74(12):1197-1205.

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