| 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 |
|---|
| Treatment of alcohol dependence; blockade of the effects of exogenously administered opioids in the management of opioid dependence (label). View labelExact | Alcohol dependence: 50 mg once daily was used in placebo-controlled outpatient trials for up to 12 weeks as an adjunct to psychosocial methods (label). | Opioid receptor antagonist used for alcohol dependence and for opioid dependence relapse prevention via opioid blockade; requires an opioid-free period to avoid precipitated withdrawal and has hepatotoxicity cautions at higher doses. | Extensive hepatic metabolism (first pass) | Single-dose mean 4 h | No | — | - Liver function testing (baseline and follow-up), especially with alcohol-related liver disease (label/clinical).
- Opioid exposure screening and documentation of opioid-free verification strategy (label/clinical).
- Monitoring for nausea, dizziness, and fatigue that can affect adherence and function (clinical).
- Perioperative/acute pain planning because opioid analgesia may be ineffective while naltrexone is active (clinical).
| No | 2026-02-12 |
|---|
| 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 |
|---|
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 |
|---|