Opioid detox Flashcards
(5 cards)
NICE guidance
Methadone or buprenorphine first-line in detoxification
Ultra-rapid detoxification must not be offered.
Rapid detoxification should only be considered for people who specifically request it, clearly understand the associated risks and are able to manage the adjunctive medication.
Accelerated detoxification should not be routinely offered. This is because of the increased severity of withdrawal symptoms and the risks associated with the increased use of adjunctive medications.
Lofexidine may be considered for people who have made an informed and clinically appropriate decision not to use methadone or buprenorphine for detoxification, who have made an informed and clinically appropriate decision to detoxify within a short time period, or for cases of mild or uncertain dependence (including young people).
Clonidine should not be used routinely in opioid detoxification.
Dihydrocodeine should not be used routinely in opioid detoxification.
Methadone
Full agonist targeting µ receptors (some action against k and δ)
15-22 hr half life
Buprenorphine
Partial agonist targeting µ receptors (also a partial k agonist or functional antagonist (possibly with antidepressant effects), and a weak δ antagonist.
24-42 hr half life (PO)
Very high affinity for µ receptor (5 times that of morphine)
Metabolised by CYP3A4/5
Naloxone
Antagonist targeting all opioid receptors
30-120 minutes half life (depending on route)
Active within minutes.
Associated with noncardiogenic pulmonary oedema in up to 3.5% of cases (pink, frothy sputum and hypoxia, usually within 4 hours of use
Naltrexone
Reversible competitive antagonist at µ and k¸ receptors (δ receptor antagonist to a lesser extent)
4-6 hours (half-life of the active metabolite is 13 hr)
Licensed for use as an adjunctive prophylactic treatment for detoxified formerly opioid-dependent people (who have remained opioid free for at least 7-10 days)
Has an active metabolite (6-βnaltrexol) which is also a reversible competitive antagonist
