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Naltrexone in either oral or injectable form is an FDA approved consideration for both opioid dependency and alcoholism. The majority of the scientific literature surrounding naltrexone is for treatment of alcoholism. For opioid dependency, it is an attractive consideration in that it can be used short term, it is not an opioid, and it has no withdrawal when discontinued.

While there are no published guidelines for duration of treatment, most providers consider naltrexone treatment a short term treatment (up to six months).

Considerations for naltrexone treatment include:

  • Opioid dependent persons need to be 7-10 days opioid free before starting naltrexone to avoid precipitating withdrawal. Therefore residential treatment is the ideal place to start naltrexone.
  • Obtaining injectable extended release naltrexone is an expensive and complex process. Because of high cost ($1,000 per injection), insurance companies vary regarding their coverage of this medication. It is a refrigerated item which is shipped from a specialty pharmacy and must be mixed on site just prior to administration.
  • The patient should have liver function studies prior to initiating naltrexone. Mild elevation of liver transaminase levels (ALT, AST) is not a reason to avoid naltrexone treatment, but we do recommend an additional set of liver function studies one month after starting treatment.
  • Patient compliance is the main issue when considering oral vs injectable naltrexone.

Our usual practice with patients who request injectable naltrexone is to start them on oral mediation while advocating to obtain the injectable form for them. If the injectable form is obtained, it is administered when appropriate. If the injectable form has not been obtained prior to the patients’ discharge, they will be discharged on oral naltrexone.


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