You don't have to answer this, but were you on any kind of opioid medication within 7 days of them giving you the patch with the naltrexone in it? If so, the naltrexone can induce immediate withdrawal symptoms. My understanding is that it's supposed to be given only with first-time opioid use, or with a carefully monitored switching procedure to avoid such a reaction.

IIRC, the idea of adding LD neltrexone to opioids is that it eliminates the euphoric effects and retards/prevents tolerance to the opioids.
Google: low dose naltrexone

Doc

Hi, Dr. Smith:

Quote: "Were you on any kind of opioid medication within 7 days of them giving you the patch with the naltrexone in it?" Before I was given the fentanyl patches with naltrexone in them, I was using the Janssen Duragesic fentanyl patches. The clinical trial was reserved for people who were using fentanyl patches (at that time, there were no generic fentanyl patches). Johnson & Johnson wanted to compare the fentanyl patches without naltrexone to the fentanyl patches with naltrexone.

Quote: "If so, the naltrexone can induce immediate withdrawal symptoms." The doctors who were taking care of the clinical trial told the Emergency Room doctors that the naltrexone was not supposed to get in the blood. In this case, replied one of the ER doctors, how could the naltrexone make the fentanyl more effective (this is what the clinical trial doctors claimed the naltrexone was supposed to do). The ER doctors thought that what the clinical trial doctors were claiming (the naltrexone supposedly making the fentanyl more effective) did not make any sense. The ER doctors thought the same thing as you, that is, that the naltrexone caused immediate withdrawal symptoms, which made me feel very, very sick.

Quote: "My understanding is that it's supposed to be given only with first-time opioid use, or with a carefully monitored switching procedure to avoid such a reaction." I did not know this. Did the clinical trial doctors and did Johnson & Johnson know this? They should have! Many people know that paramedics often use the naltrexone to reverse the overdose of heroin addicts. Of course, that must cause withdrawal symptoms in these addicts.

Quote: "The idea of adding LD neltrexone to opioids is that it eliminates the euphoric effects and retards/prevents tolerance to the opioids." The ER doctors thought they added the naltrexone to the fentanyl patches (at that time, these patches had a reservoir with the fentanyl in it) so that if a drug addict tampers with the patches to try to get high, the naltrexone would somehow get in the blood, mix with the fentanyl, and make it ineffective to protect the drug addicts from death by overdose from getting the fentanyl all at once. This is a bit confusing to me, but I think what the clinical trial doctors said is not clear. There is a lie or hiding the truth somewhere.

Hi kittycapucine1974,

Is it possible that in this case you may be confusing naltrexone with naloxone? AFAIK, naloxone is used to counter the effects of heroin or morphine overdose, while naltrexone is used for dependence treatment rather than emergency overdose treatment.

I agree with this and pretty much everything else you said. There is some acknowledged controversy about all of this, and this is why studies are being done (and it's important that they are being done) to find out.

As I understand it, they should have brought your opioid levels down considerably before trying this, and even then there is a specific protocol that must be adhered to and carefully monitored. Somebody (and possibly more than one) messed up.

Doc

Hi, Dr. Smith:

No, Dr. Smith. I have absolutely no doubt that it was naltrexone, not naloxone, that was used in some fentanyl patches during the clinical trial in which I participated.

Take a look at this (I hope the link works); I was part of a similar clinical trial done a few years earlier:

http://www.clinicaltrialsfeeds.org/c...ow/NCT00650182

If the link does not work, you will have to type the link in the box starting with http://www. (I do not know the technical name for that box).

Read what you see on this page. Then click on:

Click here to view the journal abstract from the study manuscript.

You will be able to see and read the Protocol Final Report.

Quote: "As I understand it, they should have brought your opioid levels down considerably before trying this, and even then there is a specific protocol that must be adhered to and carefully monitored. Somebody (and possibly more than one) messed up." This is also what I think. At the time of the clinical trial I participated in a few years ago, I was on the 75 mcg dosage of Duragesic.

Three things:

1. The first link works fine; the second, detailing the final report, does not.

2. My recollection is apparently deficient; this could be from initial misunderstanding or memory problems. My apologies - I need to review this stuff.

3. I now think your reaction may have been just that - some kind of bad reaction - and perhaps not a withdrawal, but I sure don't know fer sure.

Doc

Hi, Dr. Smith:

Once you click on the first link, go all the way down the page and you will find something saying "Click here to view the journal abstract from the study manuscript." You can click on the second link from this page, not from the Neuro Talk page (which was only for informative purposes). You have to have Acrobat Reader to open this pdf document. I tried this morning from my computer and it worked.

Quote: "I now think your reaction may have been just that - some kind of bad reaction - and perhaps not a withdrawal, but I sure don't know for sure." I am not sure if my problems with the fentanyl patches with the naltrexone were caused by a bad reaction or withdrawal.

Just thought I'd follow up about the low dose naltrexone.

It is off label use, my Dr. did disclose that to me. I have severe neuropathic burning pain all over my body and severe neuropathic itching too. I did one month of LDN and it was not a success for me. I had read alot about how it was this wonder drug for pain, but unfortunately it was not for me.

BTW, I use Vicodin for foot pain, and my vicodin DID NOT work when I was on the LDN.

I just googled this medication and I don't understand why it is used together with opioids. Here is what it said," Naltrexone is in a class of medications called opiate antagonists. It works by decreasing the craving for alcohol and blocking the effects of opioid medications and opioid street drugs."

This states it blocks the effects, does that mean that is also blocks the active agents that help with the pain? I'm totally confused! It also said it is used for off label use and such just like other medications are. But this is scary.

Gabbycakes

Ok, I'm not a doctor, or even a chemist, so I don't understand some of the technical stuff either. Maybe someone else here does(?) The information I get is from reading this same stuff (and some discussions from patients who've been involved).

As I understand the material, the addition of LDN supposedly blocks the euphoric effects (those that cause addiction) but not the therapeutic effects (those that alleviate pain) and also supposedly reduces/eliminates tolerance (needing more opioid for the same effect over time).

This sounds great, and will be if it turns out to be true, but it's (as we know) off-label, controversial (not universally believed/accepted) and under study.

A lot of drugs are used off-label routinely nowadays. That's how (just one example) viagra was discovered. Gabapentin, which many people are using to control the pain of Peripheral Neuropathy (PN) was originally an anti-siezure medication, and initially, use for PN was "off label". Topamax is an anti-convulsant, but is showing some promise off-label as a migraine prophylactic.

Undoubtedly, there are some bad off-label medication stories too. Like anything else, each has to be examined and validated on its own merits, which can take time and risk, depending on how desperate we are, how effective the drugs are for these off-label uses, and what risks we are willing to take for relief.

I'm as hopeful as we all are.

Doc

Hi, gabbycakes:

Quote: "I just googled this medication and I don't understand why it is used together with opioids." I personally think that naltrexone should not be used with opioids like fentanyl because these opioids will become ineffective because of naltrexone. The fentanyl patch withdrawal symptoms caused by naltrexone are pure hell. I felt so sick I could not swallow anything without vomiting bile and I thought I was going to die. I was not depressed at that time, so these thoughts of impending death were not caused by depression.

I think that when naltrexone blocks the effects of a certain family of opioids, called opioid agonists, it blocks their bad effects (respiratory depression on those who abused opioid agonists by taking too much of them, voluntarily or not) and it blocks their good effects (pain killing effects).

As long as you do not mix this type of medication (opioid agonists, such as fentanyl, oxymorphone, hydromorphone, morphine, hydrocodone, and codeine) with medications such as naltrexone, you have nothing to fear. You will still benefit from the pain killing effects of the opioids. Your doctor can reassure you.