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Long-Acting (ER) IM Naltrexone (Vivitrol) and Acute Pain Management

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My facility if currently assessing whether or not to add Vivitrol to our formulary, and one issue that has arisen is the treatment of acute pain in these individuals. The package insert is quite vague regarding what modalities to use, and contacting the manufacturer directly did not give me too much more assistance.

For example: patient on Vivitrol for OUD or AUD and has an acute onset of pain that will require emergent pain management.

It's generally understood that "pain control will be more difficult to manage" and that "non-opioids" should be used if possible, as well as that if opioids are needed to be prepared for high doses and respiratory depression.

That being said, does anyone have a more specific protocol they have utilized for treating patients in this situation? We would like to have a standard process for our patients if possible.

I apologize if this has already been answered. We have reached out to a variety of listserves and PRNs and various other outlets and we have had no responses (aside from other individuals who are curious of the answer as well).

Any information would be wonderful. Thanks!

Cory Lovec, PharmD

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I am not aware if there is a standard protocol because there is so many variables to consider in each case, and there are many non-opioid pain control approaches.

That said, this question comes up a lot but it very rarely poses clinical challenge. We have treated hundreds of cases over more than 10 years and had not any difficult situations.  Most anesthesiologists can develop/implement treatment plan that includes high-potency opioid (e.g. sulfentanil), though it will require an ICU for proper monitoring    

We have a presentation on that very topic



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