Vomiting naltrexone

Administration of naltrexone may result in anxiety, dif-ficully sleeping, abdominal cramps, nasal congestion, joint and muscle pain, nausea, vomiting, dizziness, irritability, depression, fatigue, and drowsiness. 

Accidental naltrexone overdose produces withdrawal symptoms within 5 minutes of ingestion that may last for up to 48 hours. Symptoms include confusion, visual hallucinations, somnolence, and significant vomiting and diarrhea. 

An excellent brief article on buprenorphine treatment has been provided by Taikato et al. (2005), which notes the common possible side-effects (headaches, nausea and vomiting, sweating, constipation, etc.) and drug interactions. The limited central depressant effect of buprenorphine may be compounded by alcohol and antidepressants, while the metabolism of buprenorphine can be enhanced by anticonvulsants, with therefore possibly reduced efficacy. There have been some case reports of liver toxicity from buprenorphine that is reversible if the medication is stopped (Herve et al. 2004), and often clinical guidelines will recommend that liver function tests are included in buprenorphine treatment, as they definitely should be with naltrexone. 

In 1951, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence other than detoxification. Disulfiram inhibits a key enzyme, aldehyde dehydrogenase, involved in breakdown of ethyl alcohol. After drinking, the alcohol-disulfiram reaction produces excess blood levels of acetaldehyde, which is toxic in that it produces facial flushing, tachycardia, hypotension, nausea and vomiting, and physical discomfort. Opioid receptors antagonists, such as naloxone and naltrexone (see Chapter 47) that block opioid receptors have been found to decrease alcohol consumption (Cornish et al 2004). 

Naltrexone 50 mg/day has been used to relieve pruritus in cholestatic liver disease in five patients (7). Pruritus scores fell, but two patients developed severe nausea, vomiting, light-headedness, or tremor, requiring withdrawal of treatment. The reviewers commented that these reactions may or may not have been related to opioid withdrawal and that the trial had had several design limitations. They pointed out that one concern relating to the chronic use of high-dose naltrexone is an asymptomatic rise in serum transaminases, although the doses used in this study have not been reported to produce liver function abnormalities. 

Reversible hepatocellular injury has been reported with naltrexone in doses of up to 300 mg/day, which is five times that usually used for opioid blockade (SED-11, 147) (17). Five of twenty-six patients treated with naltrexone for obesity developed raised serum transaminase activities after 3-8 weeks of treatment. In another study in which 60 obese subjects received naltrexone for 8 weeks, there were abnormal liver function tests in six patients. Three patients failed to complete the course. Nausea and vomiting occurred within the first 24 hours of treatment but responded to a reduction in dose. There were also changes in mentation such as decreased mental acuity, depression, and anxiety, all of which resolved after withdrawal. This is significant, as adverse effects from naltrexone have previously been attributed to mild physical withdrawal syndromes. 

Naltrexone 25-50 mg/day Oral 2.7 Adjunct to prevent relapse in Nausea, vomiting, abdominal pain. 

Nausea is the most common side effect of naltrexone, occurring in about 10% of patients. Other side effects are headache, dizziness, nervousness, fatigue, insomnia, vomiting, anxiety, and somnolence. 

Opiates Pupillary constriction, constipation, drowsiness, coma, slurred speech, respiratory depression, Flu-like muscle aches, nausea or vomiting, yawning, piloerection, [animation, rhinorrhea, fever, insomnia, pupillary dilation Opiates receptors, locus cereleus pathway (noradrenergic) Naloxone (short half-life), naltrexone (longer half-life), donidine (ease withdrawal), methadone, LAMM (Levo-ac-aretyl-methadol) substitute addictions,longer withdrawal period Males > Females 3 1 TB, AIDS, hepatitis, pulmonary hypertension, pneumonia... 

The adverse reactions associated with the use of naltrexone in patients with alcohol dependence tend to be mild gastrointestinal reactions (nausea, vomiting, and abdominal pain or discomfort) and they occur early in treatment [204 ]. Hepatotoxicity has been reported with high doses (100-300 mg/ day) and especially in obese individuals. Naltrexone can also precipitate opioid withdrawal and may not be suitable for those requiring future opioids, such as those requiring surgery. 

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