Naltrexone (Revia, Vivitrol) Flashcards
1
Q
Brands
A
- Oral - Revia
* Injection - Vivitrol
2
Q
Class
A
Mu opioid receptor antagonist
3
Q
Use
A
- Alcohol dependence
- Blocks effects of exogenously administered opioids (oral)
- Prevents relapse in opioid dependence (injection)
4
Q
MOA
A
- Mu opioid receptor blockade - prevents external opioid receptor binding - prevents pleasurable effects of opioid consumption
- Same with alcohol consumption
5
Q
Augment with
A
- Acamprosate
* Educate
6
Q
Tests
A
- For opioid treatment - urine screen for opioids and naloxone challenge test
- None before using for alcohol dependence, may get baseline LFTs
7
Q
S/Es
A
- N/V, decreased appetite
- Dizziness, dysphoria, anxiety
- injection site reactions (pain, tenderness, itchy, swelling, redness)
- Eosinophilic pneumonia
- Hepatocellular injury at high doses
8
Q
Dosing
A
*Range -
Oral - 50 mg/day; or 100-100-150 mg on Mon-Wed-Fri
Injection - 380 mg every 4 weeks
*Form -
Tablet 25, 50, 100 mg
Oral solution 12 mg/0.6 mL
IM 380 mg/vial
*Pt has to be opioid free fro 7-10 days before starting; confirm with negative urine screen and/or naloxone challenge test
9
Q
Dosing tips
A
- Injection- keep refrigerated; use immediately after mixing
* adherence more with injection
10
Q
Overdose
A
Nausea, abd pain, sedation, dizziness, injection site reaction
11
Q
Long term use upto
A
1 year
12
Q
Taper or not
A
No need
13
Q
Half life
A
Oral - 13 hours
Injection - 5-10 days
14
Q
Drug interactions
A
- Metabolized by dihydrodiol dehydrogenase in liver
- No CYP action
- Can block effects of some opioid containing meds like cough and cold remedies, antidiarrheal meds, opioid analgesics
15
Q
Warning/precautions
A
- Hepatocellular injury at high dose
- Pts treated with naltrexone may respond to lower doses of opioids than used earlier, causing opioid OD at lower dose
- Monitor for depressed mood, suicidality
- Caution in psych pts
- Use injection cautiously in thrombocytopenia or bleeding disorders
