Managing acute pain in patients taking naltrexone

Naltrexone has a role in relapse prevention for opioid and alcohol dependent patients. Naltrexone is an opioid antagonist, which blocks mu-receptors, preventing any pleasurable effects from subsequent opioid or alcohol use.

Managing acute pain in patients maintained on naltrexone requires specialist input because the pharmacology of naltrexone is complex. Acute pain management in these patients often requires a multimodal approach.

Opioid analgesia is often ineffective in patients taking naltrexone because naltrexone blocks all opioid effects. Naltrexone should be stopped at least 24 to 48 hours before opioids are initiated (eg preoperatively). If this is not possible (eg emergency situations), seek specialist advice. After stopping naltrexone, patients may become more sensitive to opioids and are at higher risk of opioid-induced adverse effects (eg opioid-induced ventilatory impairment).