The combination very low-dose naltrexone-clonidine in the management of opioid withdrawal.

dc.contributor.author

Mannelli, Paolo

dc.contributor.author

Peindl, Kathleen

dc.contributor.author

Wu, Li-Tzy

dc.contributor.author

Patkar, Ashwin A

dc.contributor.author

Gorelick, David A

dc.date.accessioned

2020-02-03T06:39:12Z

dc.date.available

2020-02-03T06:39:12Z

dc.date.issued

2012-05

dc.date.updated

2020-02-03T06:39:11Z

dc.description.abstract

The management of withdrawal absorbs substantial clinical efforts in opioid dependence (OD). The real challenge lies in improving current pharmacotherapies. Although widely used, clonidine causes problematic adverse effects and does not alleviate important symptoms of opioid withdrawal, alone or in combination with the opioid antagonist naltrexone. Very low-dose naltrexone (VLNTX) has been shown to attenuate withdrawal intensity and noradrenaline release following opioid agonist taper, suggesting a combination with clonidine may result in improved safety and efficacy.We investigated the effects of a VLNTX-clonidine combination in a secondary analysis of data from a double-blind, randomized opioid detoxification trial.Withdrawal symptoms and treatment completion were compared following VLNTX (.125 or .25 mg/day) and clonidine (.1-.2 mg q6h) in 127 individuals with OD undergoing 6-day methadone inpatient taper at a community program.VLNTX was more effective than placebo or clonidine in reducing symptoms and signs of withdrawal. The use of VLNTX in combination with clonidine was associated with attenuated subjective withdrawal compared with each medication alone, favoring detoxification completion in comparison with clonidine or naltrexone placebo. VLNTX/clonidine was effective in reducing symptoms that are both undertreated and well controlled with clonidine treatment and was not associated with significant adverse events compared with other treatments.Preliminary results elucidate neurobiological mechanisms of OD and support the utility of controlled studies on a novel VLNTX + low-dose clonidine combination for the management of opioid withdrawal.

dc.identifier.issn

0095-2990

dc.identifier.issn

1097-9891

dc.identifier.uri

https://hdl.handle.net/10161/20048

dc.language

eng

dc.publisher

Informa UK Limited

dc.relation.ispartof

The American journal of drug and alcohol abuse

dc.relation.isversionof

10.3109/00952990.2011.644003

dc.subject

Humans

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Opioid-Related Disorders

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Substance Withdrawal Syndrome

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Methadone

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Naltrexone

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Clonidine

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Narcotic Antagonists

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Drug Therapy, Combination

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Dose-Response Relationship, Drug

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Adolescent

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Adult

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Disease Management

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Female

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Male

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Adrenergic alpha-2 Receptor Agonists

dc.subject

Opiate Substitution Treatment

dc.title

The combination very low-dose naltrexone-clonidine in the management of opioid withdrawal.

dc.type

Journal article

duke.contributor.orcid

Mannelli, Paolo|0000-0002-7834-6138

duke.contributor.orcid

Wu, Li-Tzy|0000-0002-5909-2259

pubs.begin-page

200

pubs.end-page

205

pubs.issue

3

pubs.organisational-group

School of Medicine

pubs.organisational-group

Duke

pubs.organisational-group

Center for Child and Family Policy

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Sanford School of Public Policy

pubs.organisational-group

Duke Clinical Research Institute

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Institutes and Centers

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Duke Institute for Brain Sciences

pubs.organisational-group

University Institutes and Centers

pubs.organisational-group

Institutes and Provost's Academic Units

pubs.organisational-group

Psychiatry & Behavioral Sciences, Social and Community Psychiatry

pubs.organisational-group

Psychiatry & Behavioral Sciences

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Medicine, General Internal Medicine

pubs.organisational-group

Medicine

pubs.organisational-group

Family Medicine and Community Health, Community Health

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Family Medicine and Community Health

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Faculty

pubs.publication-status

Published

pubs.volume

38

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