On this podcast episode, I cover commonly used medications for opioid use disorder. Buprenorphine, methadone, and naltrexone are all potential options in OUD. I’ll discuss the pharmacology of each medication and the most common practice pearls that will show up in practice and on your board exams.
Naltrexone is often a first-line medication for AUD. It works as an opioid receptor antagonist, reducing the rewarding effects of alcohol and decreasing cravings. Patients frequently report that alcohol becomes less pleasurable while taking the medication. Oral naltrexone is typically dosed at 50 mg daily, while a long-acting injectable formulation is also available. Avoid use in patients taking opioids and use caution in significant liver dysfunction.
Acamprosate helps maintain abstinence by modulating glutamate and GABA neurotransmission. Chronic alcohol use disrupts the balance between excitatory and inhibitory pathways in the brain, and acamprosate helps restore equilibrium. It is primarily eliminated renally, making it a useful option in patients with liver disease. The most common adverse effect is diarrhea.
Disulfiram works through a completely different mechanism. It inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed. This can lead to flushing, nausea, vomiting, headache, and hypotension. Because of this aversive reaction, patient motivation and adherence are critical for success.
In this podcast episode, I discuss naltrexone pharmacology, adverse effects, drug interactions, and much more.
Naltrexone is an opioid antagonist and can blunt the effects of opioid agonists. Because of this, the medication can be used to manage opioid use disorder.
Hepatotoxicity is a concern of naltrexone and because of this, it is recommended to monitor LFTs.
There is an injectable, long-acting formulation of naltrexone that can be used for opioid and alcohol use disorder treatment.
