Can you experience Naltrexone Withdrawal?
Naltrexone is a prescription medication commonly used in the treatment of opioid use disorder as well as alcohol use disorder. The drug is not an opioid and therefore cannot cause naltrexone withdrawal. However, it is possible to experience symptoms of drug withdrawal if the medication is taken while opioids are still present in the body.
When users begin to feel symptoms of withdrawal while on opioid treatment medications like naltrexone and buprenorphine, they are in fact experiencing opioid withdrawal symptoms. This is a condition called precipitated withdrawal. Symptoms of precipitated withdrawal are caused when taking naltrexone while opioids are still in your system.
A 2010 study suggested that precipitated withdrawal occurs in about 9% of people who take medications such as buprenorphine to manage their opioid use disorder. Like buprenorphine, naltrexone is another common medication used in opioid use disorder treatment. Naltrexone is an opioid antagonist that blocks the effects of opioids and helps to discourage misuse of drugs and reduces cravings. It is a popular drug used in medication-assisted treatment (MAT).
How does Naltrexone work?
Naltrexone works by binding to opioid receptors in the brain. This blocks the effects of the opioids and prevents the user from experiencing the pleasurable and euphoric feelings associated with opioids. The medication is long-lasting and can last anywhere from a few hours to 48 hours.
The medication is available in pill form as well as an injectable form known by the brand name Vivitrol. The pill is taken daily while the injectable is a once a month medication due to its long lasting effects.
Naltrexone is commonly used in the treatment of both opioid use disorder and alcohol use disorder. The most common side effects of the treatment of opioids include insomnia anxiety, abdominal pain, joint and muscle pain. The most common side effects of the treatment of alcohol include nausea, headache, nervousness and dizziness.
General side effects of Naltrexone
- Nausea – Nausea is a common side effect and occurs alongside gastrointestinal issues. It usually occurs after the first injection and is mild and manageable. Over the counter medications can also be used to help ease the discomfort.
- Headache – Headaches are another common side effect, which can be treated by drinking enough water, getting enough sleep and lowering stress levels.
- Dizziness – This side effect can be caused in both oral administration and injection administration. This usually occurs when first starting the medication.
- Muscle pain and cramps – This side effect can occur with both oral and injection administration. They will eventually go away on their own.
- Increased opioid sensitivity – For some people, relapse can occur after taking naltrexone. This is because the medication lowers your tolerance for opioids. When you do use it again, you are more likely to experience an opioid overdose. This can occur even on the doses that you took before on naltrexone medication.
- Liver damage – Naltrexone can cause liver damage. It is more likely to occur in people who already have liver problems.
Can you experience Naltrexone Withdrawal?
When taking MAT medications such as naltrexone, patients should avoid taking opioids before starting the medication. In fact, opioid use should stop a few weeks before medication treatment begins. If you take naltrexone with opioids still in your system, it can almost immediately trigger symptoms of opioid withdrawal. This can also happen during an opioid relapse. Side effects include nausea, vomiting, sweating, diarrhea, irritability and abdominal pain.
Many people believe this phenomenon as naltrexone withdrawal. However, that is not true. Naltrexone does not cause physical or psychological dependence. Therefore, you cannot experience withdrawal from the medication. The withdrawal side effects and symptoms being experienced are opioid withdrawal symptoms. The term for this event is called precipitated withdrawal.
What is Precipitated Withdrawal?
Precipitated withdrawal is a condition that involves opioid withdrawal symptoms brought on by taking an opioid antagonist like naltrexone and naloxone. Precipitated withdrawal occurs when these medications are taken too soon after taking a full opioid drug like heroin or morphine. It can also occur after medication administration during an opioid overdose.
One of the defining features of precipitated withdrawal is its ability to produce a rapid onset of symptoms almost immediately. Symptoms can start within 1-2 hours after taking the medication. It will usually wear off slowly over the next 6 to 24 hours.
Some people believe they may be experiencing symptoms of naltrexone withdrawal. But it is actually withdrawal from opioids from taking the MAT medication too soon. Because of this, it is recommended that users avoid opioids for 7-10 before taking naltrexone. To avoid withdrawal symptoms you must have opioids completely out of your system when taking naltrexone. Experiencing opioid withdrawal symptoms caused by a medication treatment like naltrexone is precipitated withdrawal.
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Substances that impact Precipitated Withdrawal
Popular medications that can induce precipitated withdrawal include naltrexone, naloxone, suboxone, sublocade and Vivitrol.
Antagonists are drugs that occupy the mu-opioid receptors but do not activate them. Instead, they block the effects of opioids including the ones that are already in a person’s body. This includes the drugs naltrexone and naloxone.
Full agonist drugs have the highest risk of misuse. This includes morphine, heroin and fentanyl. These drugs mind to the mu-receptors and fully activate the receptor to its maximum capacity. When this type of drug is still in the system when naltrexone has been administered, it can cause the user to go into immediate withdrawal. The user will experience precipitated withdrawal.
Partial agonists are a class of medications that partially activate the mu-opioid receptor. This means the user will still experience the effects of opioids, but only to a certain extent. This includes the drug buprenorphine.
Symptoms of precipitated withdrawal
- Nausea
- Vomiting
- Agitation and restlessness
- Stomach pain
- Diarrhea
- Bone and muscle pain
- Elevated heart rate
- Anxiety
- Insomnia
- Sweating
- Runny nose
- Cramps
- Dilated pupils
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Treatment for Substance Use Disorder
Naltrexone is a common medication used in the treatment of opioid use disorder. It blocks the euphoric effects associated with substance abuse and helps to reduce opioid and alcohol cravings. It is often prescribed to help discourage the abuse of opioids. In some cases, the administration of naltrexone can cause a person to go into withdrawal. This is not naltrexone withdrawal. This is opioid withdrawal. This occurrence is also referred to as precipitated withdrawal.
Behavioral health treatment programs such as Hotel California by the Sea specialize in opioid use disorder and alcohol use disorder treatment. We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-based methods such as CBT, DBT and EMDR therapy. Hotel California by the Sea is dedicated to helping clients reach their goals in recovery and overcome their addiction.
References:
https://www.goodrx.com/naltrexone/common-naltrexone-side-effects
https://www.medicalnewstoday.com/articles/drugs-naltrexone-tablet-side-effects#specifics
https://www.medicalnewstoday.com/articles/precipitated-withdrawal
https://www.bicyclehealth.com/opioid-education/precipitated-withdrawal