A largely used medication for rapid opiate detox, Naltrexone is favored since it blocks the opiate receptors while a patient stays unconsciousness under the influence of general anesthetics. The medication is administered orally and its use may extend to several months depending upon the severity of the dependence. Naltrexone implants are widely used for long-term administering; though its effects are dubious, but it provides for better medication compliance. Still, the efficacy of rapid opiate detox with Naltrexone stays questionable on treating long-term opiate dependence.
Naltrexone is N-cyclopropylmethyl derivative, best described as substituted oxymorphone with the tertiary amine methyl-substituent replaced with methyl-cyclopropane. Upon sustained release, naltrexone has shown results which could be termed as promising, but within a small segment of opiate addicts. However, the medication just treats physical dependence; for a complete effect, further psycho-social interventions are important.
Not only opiates, naltrexone finds its usage in treating alcohol dependence as well. However, Naltrexone is not Methylnaltrexone Bromide used for treating opiate-induced constipation; neither is it similar to naloxone used for emergencies such as an overdose. Naltrexone has a longer effect than naloxone, which makes Naltrexone a better choice for long-term opiate detox. However, Naltrexone treats ethanol dependence more effectively than opiate dependence, though the mechanism of action of the medicine is yet to be fully understood. It could be due to the modulation of the dopaminergic-mesolimbic pathway which is activated by ethanol.
Naltrexones most common side effects include nausea (noticed in around 10% of people), headache and fatigue (around 7%), dizziness (4% or less), insomnia (3% at most), anxiety and drowsiness (near about 2%). They are; however, mild and of short duration, though 5% to 10% of the patients have shown severe nausea and resulted in stopping the treatment. However, Naltrexone, if administered in amounts more than whats required may initiate liver toxicity; hence, liver function tests are important prior to the treatment begins.
Post-detox Naltrexone administering requires test doses of 25 mg for an hour; it gauges for any further opiate withdrawal symptoms. Without any problems appearing, another 25 mg are administered. The subsequent doses are as follows:
i. 50 mg daily for 5 consecutive days of a week and 100 mg on the 6th day.
ii. 100 mg every alternate day.
iii. 150 mg every three days.
iv. 100 mg on the starting and the middle of the week, followed by 150 mg a day later.
v. 150 mg on the start of the week and 200 mg after two days.
However, this is on an average, since opiate detox and dependence treatment varies with the need of every patient. Besides, it is required keeping in mind that naltrexone may prove toxic, inflicting considerable liver damage, which makes periodic liver function tests an important part of an opiate detox program with naltrexone.
As the last notes, naltrexone alone doesnt immune the body against opiates; it just suppresses the analgesia and an opiates euphoric effects. Therefore, disulfiram is most commonly used as a combination drug, though it increases the chances for an increased liver toxicity, making a professional medical consultation paramount for outweighing the risks.
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