cocktail for transition from bup to naltrexone...

Buprenorphine Post
drpasser
Posts: 1404

Postby drpasser » Mon Feb 06, 2012 7:27 am

Voltarin?

That's fine.

As far as starting naltrexone, I would want my pt completely off all opiates for at least one week, maybe two weeks. I would then challenge with 12.5 mgs naltrexone and go up on the dose from there and as tolerated. Alot of GI upset is common. I have tried to use naltrexone a bunch of times, many pts do not care for it and won't take it.

KP

entjwb
Posts: 180

Postby entjwb » Mon Feb 06, 2012 7:27 am

DR Passer, I prefer Diclofenac 75 mg to ibuprofen for pain. Also, doesn't have the GI side effects like Ibuprofen.

MChaplin
Posts: 183

Postby MChaplin » Mon Feb 06, 2012 7:27 am

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 help- i have never made this transition but i have a number of clients who have continued to dabble with opiods and i can't justify continuing suboxone so i need an alternative- esp if methadone and/or residential treatment are not opions.

drpasser
Posts: 1404

Postby drpasser » Mon Feb 06, 2012 7:27 am

First. I don't use Klonopin. I do recommend clonidine, I like to give a 0.1 mg test dose and if OK after an hour, I have the pt apply a Catapress TTS # 1 skin patch for five days, then remove it. Next, to handle aches and pains, you can use ibuprofen 400-600 mgs TID-QID for a few days. You may want to give omeprazole 20 BID during this time to prevent dyspepsia. Trazadone is fine for sleep. Finally, recommend dicyclomine (Bentyl) 10-20 mgs TID-QID for rebound GI effects-cramping, diarrhea, etc. And Gatoraid/Poweraid.
Best,
Kevin M. Passer, M.D. FAPA


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