Naltrexone Hydrochloride(nal trex’ one)
ReVia, Vivitrol
PREGNANCY CATEGORY C
Drug class
Opioid antagonist
Therapeutic Actions
Pure opiate antagonist; markedly attenuates or completely, reversibly blocks the subjective effects of IV opioids, including those with mixed opioid agonist-antagonist properties.
Indications
Adjunct to treatment of alcohol or opioid dependence as part of a comprehensive treatment program
Prevention of relapse to opioid dependence following opioid detoxification
Unlabeled uses: Eating disorders, pathologic gambling, IBs, PTSD, pruritus, smoking cessation
Contraindications and Cautions
Contraindicated with allergy to opioid antagonists, acute hepatitis, liver failure, any patient who has failed the naloxone challenge.
Use cautiously with opioid addiction (may produce withdrawal symptoms; do not administer unless patient has been opioid-free for 7–10 days); opioid withdrawal; lactation; depression, suicidal tendencies; pregnancy.
Available Forms
Tablets—50 mg; injection—380 mg/vial
Dosages
Warning Give naloxone challenge before use except in patients already showing clinical signs of opioid withdrawal.Dosages
Adults
IV challenge test
Draw 2 ampules of naloxone, 2 mL (0.8 mg) into a syringe. Inject 0.5 mL (0.2 mg) IV. Leave needle in vein, and observe for 30 sec. If no signs of withdrawal occur, inject remaining 1.5 mL (0.6 mg), and observe for 20 min for signs and symptoms of withdrawal (stuffiness or running nose, tearing, yawning, sweating, tremor, vomiting, piloerection, feeling of temperature change, joint or bone and muscle pain, abdominal cramps, skin crawling).
Subcutaneous challenge
Administer 2 mL (0.8 mg) naloxone subcutaneously, and observe for signs and symptoms of withdrawal for 20 min. If any of the signs and symptoms of withdrawal occur or if there is any doubt that the patient is opioid- free, do not administer naltrexone. Confirmatory rechallenge can be done within 24 hr. Inject 4 mL IV, and observe for signs and symptoms of withdrawal. Repeat until no signs and symptoms are seen and patient is no longer at risk.
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