Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone.
Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone.
复制标题
DOI：
10.1007/s40264-018-0705-8
复制
发表时间：
2018-10
期刊：
影响因子：
4.2
通讯作者：
Glanz JM
中科院分区：
文献类型：
--
作者：
Binswanger IA;Glanz JM
缓释（ER）注射纳曲酮（Vivitrol®）是美国批准用于治疗阿片类药物使用障碍的月度注射剂。阿片类药物使用障碍的其他治疗方法包括阿片类药物激动剂或部分激动剂，如美沙酮和含有丁丙诺啡的产品（如丁丙诺啡那洛酮）。作为一种阿片类拮抗剂，纳曲酮阻断阿片类药物的欣快作用，一旦个体被成功诱导接受治疗，可能会降低阿片类药物过量的风险。然而，矛盾的是，如果个体试图挑战与纳曲酮bbb相关的阿片类药物阻断，阿片类药物过量的风险可能会增加。最近的两项研究引起了人们对与ER注射纳曲酮相关的阿片类药物过量易感性的关注。在一项比较丁丙诺啡那洛酮与ER注射纳曲酮有效性的随机试验（n= 570）中，ER注射纳曲酮组有15人发生18次过量事件，而丁丙诺啡-纳洛酮组有8人发生10次过量事件；据报道，发生事件的个体数量差异无统计学意义（p= 0.14），但过量用药个体的相对比例仍然令人担忧（5.3%对2.8%）。西澳大利亚的一项观察性研究表明，与接受美沙酮治疗的男性相比，接受另一种ER纳曲酮（植入纳曲酮）治疗的男性死亡过量的风险更高，但当男性和女性联合使用b[4]时没有差异。总的来说，关于缓释纳曲酮过量用药风险的先前数据很难解释，因为研究中确定过量用药的程序不一致且描述不清[10]。先前的一项研究也注意到停止ER注射纳曲酮[3]治疗后的过量事件，可能是由于治疗期间耐受性的丧失。其他治疗阿片类药物使用障碍的药物与停药后服药过量的风险升高相关[3,6]。动物研究表明，如果纳曲酮导致mu受体上调，则治疗后用药过量的风险可能会加剧[7,8]。目前，比较ER注射纳曲酮治疗后安全性与美沙酮、丁丙诺啡治疗后风险的数据缺乏。安全性数据将帮助临床医生和患者在治疗方案中做出明智的决定。
Extended-release (ER) injectable naltrexone (Vivitrol®) is a monthly injection approved for the treatment of opioid use disorder in the US. Other treatments for opioid use disorder include opioid agonists or partial agonists such as methadone and buprenorphine-containing products (eg buprenorphinenaloxone). As an opioid antagonist, naltrexone blocks the euphoric effects of opioids and may reduce the risk of opioid overdose once individuals are successfully induced into treatment [1]. However, paradoxically, the risk of opioid overdose may increase if individuals try to challenge the opioid blockade associated with naltrexone [2]. Two recent studies raise concerns about the susceptibility to opioid overdose associated with ER injectable naltrexone. In a randomized trial (n= 570) comparing the effectiveness of buprenorphinenaloxone with ER injectable naltrexone, 15 individuals had 18 overdose events in the ER injectable naltrexone arm, compared with 8 individuals who had 10 overdose events in the buprenorphine-naloxone group; the difference in the number of individuals with events was reported to be not statistically significant (p= 0.14), but the relative proportion of individuals with overdoses was nonetheless concerning (5.3% vs. 2.8%)[3]. An observational study in Western Australia demonstrated an elevated risk of fatal overdose among men treated with a different formulation of ER naltrexone (implant naltrexone), relative to men treated with methadone, but there was no difference when men and women were combined [4]. Overall, prior data about overdose risk associated with extended-release naltrexone is difficult to interpret due to inconsistent and poorly described procedures for ascertaining overdoses across studies [5]. A prior study also noted overdose events after discontinuing treatment with ER injectable naltrexone [3], perhaps due to loss of tolerance during treatment. Other medications for opioid use disorder are associated with an elevated risk of overdose after treatment discontinuation relative to ontreatment periods [3, 6]. This post-treatment overdose risk may be exacerbated if naltrexone results in upregulation of mu receptors, as suggested by animal studies [7, 8]. At present, there is a paucity of data comparing the post-treatment safety of ER injectable naltrexone with the post-treatment risk of methadone and buprenorphine. Safety data would help clinicians and patients make informed decisions among treatment options.
登录
查看更多内容
影响因子：
4.4
作者：
Kelty, Erin;Hulse, Gary
通讯作者：
Hulse, Gary
影响因子：
3.9
作者：
Jarvis, Brantley P.;DeFulio, Anthony;Silverman, Kenneth
通讯作者：
Silverman, Kenneth
影响因子：
3.3
作者：
Unterwald, EM;Anton, B;Evans, CJ
通讯作者：
Evans, CJ
影响因子：
33.9
作者：
Seth, Puja;Scholl, Lawrence;Bacon, Sarah
通讯作者：
Bacon, Sarah
DOI：
10.1136/bmj.j1550
发表时间：
2017-04-26
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Sordo L;Barrio G;Bravo MJ;Indave BI;Degenhardt L;Wiessing L;Ferri M;Pastor-Barriuso R
通讯作者：
Pastor-Barriuso R