Treatment of opiod dependence includes:
B i.e. Naltrexone Management of Opioid related Disorders - Opiate (eg heroin) toxicity and overdose (intoxication) management requires IM/IV naloxone (drug of choice)Q, or nalmefene, suppo of vital functions (02, positive pressure breathing, IV fluids, pressor agents for hypotension & cardiac monitoring for QT prolongation) and intubation (+-). In opioid dependent (& intoxicated) patients administration of opioid antagonists (eg naloxone & nalmefene; both approved for overdose/intoxication) may produce signs of opioid withdrawl (precipitated opioid withdrawl) as well as reversal of overdose. A relative advantage of naloxone is that withdrawl effects are of sho duration (ti/2 = 60-90 min) in comparison to nalmefene (t1/2 = 10 hours) Opioid related disorder Drugs Used Overdose/Intoxication Naloxone (1st), Nalmefene (2nd)Q Withdrawl Symptoms Methadone (1st), Buprenorphine (symptomatic relief) (2nd), LAAM (no longer used), Clonidine/ Lofexidine (3rd), Benzodiazepines & Tramadol Withdrawl Treatment All above + Naltrexone (for rapid (Detoxification) detoxifiation; however it can't be used alone) Opioid Dependence Methadone , Buprenorphine, (Maintenance LAAM (no longer used / treatment) available / recommended), Naltrexone (to prevent relapseQ) Opioid withdrawl syndrome (symptoms) can be treated by weak or paial opioid agonist such as methadone (drug of 1" choice)Q, buprenorphine (drug of 2" choice)Q, LAAM (not recommended as it prolongs QT interval) and a2 adrenergic agonist drugs such as clonidine (drug of 3rd choice)Q and lofexidineQ (clonidine analogue with less hypotensive effect). Weak or paial opioid agonists act by stabilizing the patient on an equivalent drug with less addition/abuse potential, and then the substituted drug is gradually withdrawn. Whereas, a-2 adrenergic agonist drugs are centrally acting sympatholytic agents with no addiction and no narcotic action and relieve opioid withdrawl symptoms by reducing central sympathetic outflow (noradrenergic hyperactivity). Opiate withdrawl treatment (or detoxification) is done by methadone (1st choice), buprenorphine (2nd), LAAM (not recommended), clonidine (3rd) and lofexidineQ. Opioid antagonist naltrexone combined with az adrenergic agonist is used to shoen the duration of withdrawl with out significantly increasing patient discomfo (i.e. rapid & ultra rapid opiate detoxification = ROD). Another benefit of ROD is reduced time between opioid use and commencement of sustained naltrexone treatment for prevention of relapseQ. Ultrarapid opiate detoxification is an extension of ROD using anesthetics. Alpha 2 adrenergic agonists are primarily used for detoxification (treatment of withdrawl symptoms). Weak agonist and paial opioid agonist medications are commonly used for detoxifiation (treatment of withdrawl symptoms) and maintenance treatment for opioid dependence. Opioid antagonists (eg naltrexone) are used to accelerate detoxification (used in withdrawl treatment but does not treat withdrawl symptoms) and then continued post detoxification to prevent relapseQ. Opioid antagonist naltrexone must be staed after detoxification or with a2 agonist, to prevent withdrawl symptoms. For opioid dependence (chronic use), FDA approved maintenance treatment include opioid agonists methadone, buprenorphinQ and LAAM (not preferred; but theoritically can be given) and opioid antagonist naltrexoneQ. Cognitive behavior therapy, psychodynamic & interpersonal therapies, self help and 12-step group therapy, behavioral therapies and therapeutic communities help to achieve opioid abstinence.
Naloxone
Naltrexone
Acamprostate
All