whats the diff b/w naloxone and naltrexone

[mountaindew2006]

I know theyre both competitve blockers of opiod receptors. is there a difference? only thing i found is that naltrexone works faster...

i've just read that there is a difference, but just dont know what...figured you all in the EM feel would know the best.

thanks

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[fuegorama]

I'm an MSII, but in my wisened opinion you have it backwards. 😉
Naloxone is your fast-acting, parenterally administered antagonist indicated in the patient with OD/coma of unknown origin . It has a very short T1/2, and frequently needs to be readministered in these cases.

Naltrexone exhibits great oral bioavailability and a much longer T1/2. It is used primarily for long term dependence and addiction in s/p detox individuals.


Interesting EM tox. trivia-
Naloxone is mixed with oral pentazocine
(a mu and kappa agonist). This allows normal dosing in the pill form, but discourages "cooking" down tablets for IV use.

 

[mountaindew2006]

I'm an MSII, but in my wisened opinion you have it backwards. 😉
Naloxone is your fast-acting, parenterally administered antagonist indicated in the patient with OD/coma of unknown origin . It has a very short T1/2, and frequently needs to be readministered in these cases.

Naltrexone exhibits great oral bioavailability and a much longer T1/2. It is used primarily for long term dependence and addiction in s/p detox individuals.


Interesting EM tox. trivia-
Naloxone is mixed with oral pentazocine
(a mu and kappa agonist). This allows normal dosing in the pill form, but discourages "cooking" down tablets for IV use.

indeed you are correct. my bad. yah i was actually at school today and i saw that...my bad...good catch 👍

 

[joshua_msu]

And then there is Nalmafene

 

[ERMudPhud]

And then there is Nalmafene

AKA How to be really mean to your neighborhood junkie.

 

[ThinkFast007]

AKA How to be really mean to your neighborhood junkie.

so....in terms of exams....shelf exams in particular, if someone comes in with opiod withdrawl sx's do you use nalaxone or nalmefene ? or naltrexone?

I assume either nalaxone or nalmefene since theyre both parenteral or sub q?

is there a preference though over which one?

thanks

 

[joshua_msu]

so....in terms of exams....shelf exams in particular, if someone comes in with opiod withdrawl sx's do you use nalaxone or nalmefene ? or naltrexone?

I assume either nalaxone or nalmefene since theyre both parenteral or sub q?

is there a preference though over which one?

thanks

I dont believe you would give any for opioid witdrawl symptoms, since they precipitate withdrawl. I think the standard treatment for opiod withdrawl is benzo's.

 

[riopsedm]

a way to remember that one of my classmates came up with...

naltrexone keeps people from trekking back to the ER later on for withdrawal sx...

 

[docB]

I think the standard treatment for opiod withdrawl is benzo's.

And clonidine.

 

[Apollyon]

And clonidine.

A cardiologist directed what we talked about towards EM last year on rounds when I was off-service, and he said that, in Baltimore when he was IM, they would almost never write for clonidine tabs (patch only), because dealers would sell the clonidine for $5/10 each to take the edge off the jones until the crackers and junkies could cobble together the scratch needed for the next hit.

 

[bemused]

... to take the edge off the jones until the crackers and junkies could cobble together the scratch needed for the next hit.

Wow, you're really up on the street lingo!

 

[EMResident]

A cardiologist directed what we talked about towards EM last year on rounds when I was off-service, and he said that, in Baltimore when he was IM, they would almost never write for clonidine tabs (patch only), because dealers would sell the clonidine for $5/10 each to take the edge off the jones until the crackers and junkies could cobble together the scratch needed for the next hit.

Beware prescribing patches -- they can be cut into small strips and then boiled into tea by well-meaning opiod users. They then get 24 hours worth of clonidine in one gulp. One tab of clonidine taken while and RN or I'm watching is all I give (followed by mouth inspection).

 

[Apollyon]

Beware prescribing patches -- they can be cut into small strips and then boiled into tea by well-meaning opiod users. They then get 24 hours worth of clonidine in one gulp. One tab of clonidine taken while and RN or I'm watching is all I give (followed by mouth inspection).

Now that's what I call progress!

 

[emtp2pac]

apparently even more fun with fentanyl/duragesic patches. I have heard stories of people taking used ones out of the trash on oncology services for this purpose.....