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by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

do you do any kind of naloxone challenge before starting the naltrexone? or check urine for signs of buprenorphine? how long does it take from the last dose of buprenorphine until it is safe to start naltrexone? i am guessing it depends a lot on what the dose was before stopping? thanks for your hel...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

my experience with naltrexone has been similar - but i am not sure what else to do- i am not comfortable with suboxone and concurrent agonist opiod use- so my alternatives are limited-
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

thanks- i thought of that but these are folks that are already on 3 strips a day- so 24mg- i actually worry that the high dose is part of the problem- they may be diverting and buying oxy or whatever with their profits-so these are not necessarily "ideal" patients to begin with but they do legit hav...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

Dr Passer- when you use 12.5mg naltrexone- do you have the pt break the 50mg into 4ths? the only dose available here in CT is a 50mg tab...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

That is extremely helpful information- how do you get 1mg naltrexone? i ended up sending pt to detox where they are will be treated with methadone- any suggestions on how to adjust protocol for that? how much clonazepam are you allowing? do you think neurontin 600mg tid is even worth trying for the ...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

thanks again for the additional details- when you say small amount of klonopin, what are you talking about? and when you push the dose from day3-6- how often are you dosing? do you think that if i started on day 5, i could start with 12.5 (1/4 tablet) to avoid the need for a compounding pharmacy? or...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

I found the module online at http://pcssmat.org/wp-site/wp-content/uploads/2014/02/PCSS-MAT-Implementing-Antagonist-Based-Relapse-Prevention-Treatment-for-Buprenorphine-Treated-IndividualsNOCME.pdf. It was very informative and exciting- thank you very much -
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

the link IS tempermental- sometimes it works and sometimes it does go to an error page- i ended up saving the module as a pdf- but i don't know how to attach it here...keep trying though because there is alot of helpful information- mayby Dr Bisaga can have someone take a look at the website...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

The cost of vivitrol in CT that i was quoted was $1300 per dose and I am having a great deal of trouble getting it approved but i intend to keep trying. I am intrigued by studies showing vivitrol reduces cravings when data and anecdotal experience suggest oral immediate release naltrexone does not- ...
by MChaplin
Mon Feb 06, 2012 7:27 am
Forum: Clinical Use of Buprenorphine
Topic: cocktail for transition from bup to naltrexone...
Replies: 43
Views: 19419

i have a pt coming out of inpt next week- ready to start vivitrol the day he gets out- which seems safe enough as he has been there 30 days- his mother is very concerned that he will "test" and based on the above that doesnt seem unlikely- he went inpt because he kept "testing" on suboxone though he...

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