SUD agents Flashcards
(18 cards)
Suboxone (Buprenorphine/Naloxone) class
opioid analgesic, opioid partial agonist
Buprenorphine MOA
high affinity binding to mu opiate receptors in CNS; partial mu agonist and weak kappa antagonist activity
Naloxone MOA
pure opioid antagonist that competes with and displaces opioids at opioid receptor sites
Suboxone (Buprenorphine/Naloxone) dosing for opioid use disorder (INDUCTION)
Sublingual film:
Day 1: 2/0.5mg or 4/1mg may titrate dose based on control of acute withdrawal symptoms in 2/0.5 or 4/1 mg increments about every 2 hrs up to a total dose of 8/2mg
Day 2: up to 16/4 mg as a single dose
Suboxone (Buprenorphine/Naloxone) dosing for opioid use disorder (MAINTENANCE)
16/4 mg QD
Suboxone (Buprenorphine/Naloxone) ADE
- dental (tooth decay, dental caries, dental abscesses/infection, tooth erosion, fillings falling out, total tooth loss)
- constipation
- respiratory depression
- withdrawal sx
- sweating
- abdominal pain
- constipation
- nausea
- headache
- withdrawal syndrome
Suboxone (Buprenorphine/Naloxone) hepatic impairment dosing
Mild: no adjustment needed
Moderate: use with caution as maintenance treatment, avoid use for induction
Severe: avoid use
Suboxone (Buprenorphine/Naloxone) altered kidney function dosing
no adjustment needed
Vivitrol (Naltrexone) class
antidote: opioid antagonist
Vivitrol (Naltrexone) MOA
pure opioid antagonist
Vivitrol (Naltrexone) AUD dosing
PO: 50mg QD, may increase to 100mg QD after one week based on response
IM: 380 mg once every 4 weeks
Vivitrol (Naltrexone) OUD dosing
PO: 25mg QD for 1-3 days, then 50mg QD thereafter
IM: 380mg once every 4 weeks
Vivitrol (Naltrexone) altered kidney function dosing
caution in moderate to severe impairment
Vivitrol (Naltrexone) hepatic impairment dosing
use not recommended in acute hepatitis or hepatic failure
Vivitrol (Naltrexone) ADE
- accidental opioid overdose (pts hypersensitive to opioids after treatment)
- hepatotoxicity
- injection site reactions
- withdrawal symptoms
- syncope
- abd pain, change in appetite, diarrhea, N/V
- anxiety, depression, dizziness, drowsiness sleep disorder, suicidal ideation
- xerostomia
- back/muscle pain
Transitioning from buprenorphine to naltrexone
1.) taper buprenorphine gradually and DC
2.) wait 7-14 days before initiating naltrexone
- Naloxone challenge may be used to demonstrate an absence of physical dependence
Transitioning from methadone to naltrexone
1.) taper methadone gradually and DC
2.) wait 7-14 days before initiating naltrexone
- Naloxone challenge may be used to demonstrate an absence of physical dependence
Transitioning from naltrexone to methadone or buprenorphine
begin methadone or buprenorphine when patient is due for next dose of naltrexone
