naloxoneAdjunctive therapyBrands: Narcan | Emergency treatment of known or suspected opioid overdose (label). View labelExact | Intranasal naloxone devices are single use. Labeling for Narcan nasal spray recommends administering one spray into one nostril as quickly as possible when overdose is suspected (label).
If the person does not respond, or responds and then relapses into respiratory depression, additional doses can be administered every 2–3 minutes using a new device each time and alternating nostrils (label). | Opioid receptor antagonist used for the emergency treatment of known or suspected opioid overdose (respiratory and/or CNS depression). Because naloxone’s duration is often shorter than the opioid involved, repeat dosing and emergency medical evaluation are commonly required (label/guideline). | Hepatic glucuronidation to naloxone-3-glucuronide (label) | Single-dose range 0.5–2.1 h | No | — | - After administration, continued surveillance is essential because recurrent respiratory depression can occur; labeling emphasizes repeat dosing when needed while emergency services are activated (label).
- Monitor for withdrawal-related agitation and vomiting with attention to airway/aspiration safety (label/clinical).
- When naloxone is co-prescribed, clinicians often review overdose recognition, device use, storage, and expiration tracking with patients and close contacts (clinical).
| No | 2025-12-31 |
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| Opioid use disorder treatment (induction and maintenance) (label). View labelExact | Treatment is often structured in phases (induction, stabilization, maintenance) with dose changes guided by withdrawal symptoms, cravings, and safety (guideline/clinical).
Induction timing is individualized by opioid type and timing of last use; objective withdrawal assessment is commonly used to reduce precipitated withdrawal risk (label/guideline). | Combination of buprenorphine (partial μ-opioid receptor agonist) and naloxone (opioid antagonist) used for treatment of opioid use disorder. Naloxone has low bioavailability sublingually but deters injection misuse (label/guideline). | CYP3A4 (buprenorphine), UGT1A1/UGT2B7 (buprenorphine glucuronidation) | Single-dose range 24–42 h | No | | - Early follow-up to assess withdrawal control, cravings, sedation, and adherence (guideline/clinical).
- Review concurrent CNS depressants at each visit and reassess risk when new sedating medications are started (label/clinical).
- Monitor for diversion/misuse as clinically indicated (structured follow-up, PDMP review, urine drug testing depending on setting) (guideline/clinical).
- Consider hepatic monitoring when baseline liver disease is present or when symptoms emerge (label/clinical).
| No | 2026-02-12 |
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methadoneAdjunctive therapyBrands: Methadose, Dolophine | Opioid use disorder maintenance in certified opioid treatment programs and analgesia (label varies by product). View labelExact | Opioid use disorder (OUD) dosing is typically managed within an opioid treatment program, with dose changes guided by withdrawal control, cravings, and safety (guideline/clinical).
Because accumulation risk is highest early in treatment, many programs avoid rapid escalation and reassess frequently after dose changes (label/clinical). | Long-acting full μ-opioid receptor agonist used for opioid use disorder maintenance (in regulated opioid treatment programs) and for analgesia. Long and variable half-life can lead to accumulation and overdose risk if titration is too rapid (label/guideline). | CYP2B6, CYP3A4, Other CYP enzymes (variable; label) | Single-dose range 8–59 h | No | | - Monitor sedation and respiratory status during initiation and after dose increases; reassess concurrent sedatives and polysubstance use risk (label/clinical).
- QTc planning: consider ECG monitoring when cardiac risk factors, high doses, or QT-active co-medications are present (label/clinical).
- Monitor for constipation and other opioid adverse effects that can affect adherence and quality of life (clinical).
- Reassess withdrawal control and cravings and adjust treatment supports (housing, therapy, peer support) when available (guideline/clinical).
| No | 2026-02-22 |
|---|
| Alcohol dependence; opioid relapse prevention after detoxification (label). View labelExact | Recommended dose is 380 mg as a deep IM gluteal injection every 4 weeks or once a month, alternating buttocks each injection (label). | Monthly extended-release injectable naltrexone (opioid antagonist) used for alcohol dependence and for opioid relapse prevention after detoxification. Requires an opioid-free interval to avoid precipitated withdrawal and carries important injection-site, hepatotoxicity, and overdose-vulnerability warnings (label/guideline). | Extensive metabolism to 6β-naltrexol via dihydrodiol dehydrogenase (non-CYP) (label), Glucuronide conjugation (label) | Single-dose range 120–240 h | No | — | - Confirm opioid-free status before initiation; plan for higher-risk transitions from methadone or buprenorphine (label/clinical).
- Monitor injection sites for severe reactions and ensure appropriate administration technique (deep IM gluteal) (label/clinical).
- Monitor liver symptoms and liver enzymes when indicated, especially in alcohol-related liver disease (label/clinical).
- Monitor mood and suicidality, particularly in patients with comorbid depression (label/clinical).
- Review overdose risk education and consider naloxone access planning (label/clinical).
| No | 2026-02-12 |
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