Articles: narcotic-antagonists.
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Opioid treatment of pain is generally safe with 0.5% or less events from respiratory depression. However, fatalities are regularly reported. The only treatment currently available to reverse opioid respiratory depression is by naloxone infusion. ⋯ An opioid with high receptor affinity will require greater naloxone concentrations and/or a continuous infusion before reversal sets in compared with an opioid with lower receptor affinity. The clinical approach to severe opioid-induced respiratory depression is to titrate naloxone to effect and continue treatment by continuous infusion until chances for renarcotization have diminished. New approaches to prevent opioid respiratory depression without affecting analgesia have led to the experimental application of serotinine agonists, ampakines, and the antibiotic minocycline.
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Pruritus is an unpleasant sensation leading to scratching. It can be a feature of numerous skin or systemic diseases, and may also be a side-effect of various drugs. Opioids are one of the best-known medicines evoking pruritus. ⋯ Opioid antagonists seem to be the most potent antipruritic drugs, but they also decrease analgesia, which limits their usage. Many other treatments have been tried, but to date, the data are conflicting or only limited studies have been performed to confirm their efficacy. Further studies are still needed to better elucidate the mechanism of opioid-induced pruritus and to develop more effective treatment options.
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Case Reports
'I saved a life': a heroin addict's reflections on managing an overdose using 'take home naloxone'.
Research shows that most heroin addicts, at some point in their drug using careers, accidentally overdose and that accidental overdose is the most common cause of death in this group. As most such overdoses are witnessed by other drug users or their carers, it is argued that providing 'take home naloxone' (a fast-acting opiate antagonist) to them (as potential witnesses to an overdose) can save lives. ⋯ Through this account, we hope to raise clinicians' awareness of this simple yet life-saving intervention. We will also briefly discuss the evidence base for take home naloxone with particular reference to the UK and will also give some practical guidance to clinicians on prescribing take home naloxone.
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Drug Alcohol Depend · Jan 2010
Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy.
Buprenorphine/naloxone was approved by the FDA for office-based opioid maintenance therapy (OMT), with little long-term follow-up data from actual office-based practice. 18-Month outcome data on the office-based use of buprenorphine/naloxone (bup/nx) and the impact of socioeconomic status and other patient characteristics on the duration and clinical effects of bup/nx are reported. ⋯ Bup/nx-OMT is a viable treatment option and when coupled with a required abstinence oriented addiction counseling program is effective in promoting abstinence, self-help group attendance, occupational stability, and improved psychosocial outcomes in both low SES and high SES patient populations over an 18-42-month period.
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J. Clin. Endocrinol. Metab. · Dec 2009
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of combined bupropion and naltrexone therapy for obesity with monotherapy and placebo.
The efficacy of current centrally acting obesity pharmacotherapies is limited by compensatory mechanisms that mitigate weight loss. ⋯ NB caused gradual sustained weight loss over 48 wk; NB32 and NB16 demonstrated greater weight loss in the intent-to-treat population due to lower attrition rates. Further study is needed to demonstrate long-term efficacy and safety of NB.