Friday, May 18, 2012

Important Notice: Naltrexone Relieves Suboxone Post-Acute Withdrawal Symptoms

I recently saw a patient who we detoxed off Suboxone about 2 years ago. He is staying clean and doing very well – He feels very happy, has a new career, is getting on well with friends and family. But, he has been plagued with Post-Acute Withdrawal Symptoms (PAWS). Interestingly, his symptoms virtually went away when he started back on Naltrexone.

The patient felt well after he detoxed off Suboxone, but he noticed that when his implant wore off he became fatigued, couldn’t sleep and felt physically tired.  He said it didn’t feel like depression (“it felt more physical than that”), but his doctor wanted to treat him for depression.  He also had other post-acute withdrawal symptoms including sneezing attacks and cold chills.  He saw his doctor who tested him for a variety of things, and tried him on a variety of medicines but nothing helped him.  His symptoms improved somewhat but he continued to feel very tired and fatigued.  After about 18 months, he was searching on the internet when he found reference to the fact that some people have persistent post-acute withdrawal symptoms when they come off Suboxone.  Some of these people respond well to taking Naltrexone.  So, about 6 months ago, my patient called on the phone and we started him on Naltrexone tablets. Within 1 hour he was feeling like he was 18 years old again.  He said he had so much energy and felt so good that it scared him.  His feelings of high energy lasted about 5 days, but then settled down into what felt like normal energy.  He has felt pretty good ever since.  One day he forgot his Naltrexone and he started to feel bad again, but he felt normal again as soon as he resumed his Naltrexone.

I have heard from other doctors who have patients who have had similar experiences – the patients stopped opiates, had persistent mild sub-acute withdrawal symptoms, and then the withdrawal symptoms were relieved by Naltrexone.  Of course, we use Naltrexone routinely after our detoxes, and most of our patients feel very well very quickly.  Most of our patients have virtually no cravings.

It is hard to understand exactly why Naltrexone could relieve these post-acute withdrawal symptoms, but I have a couple of thoughts.  Naltrexone binds tightly to the opiate receptors in the brain, and prevents other opiates from attaching to them. Perhaps, because Naltrexone blocks these receptors it forces the brain to more quickly increase its production of natural endorphins, and this increase in endorphins is what relieves the fatigue and other symptoms.  Perhaps, the Naltrexone binding fills the receptors up, so that they are not “looking for drugs” – cravings and withdrawal symptoms go down.  Perhaps, filling the receptors up with a blocking drug allows the number of receptors to go back to a normal state – a process we call “Down Regulation” – and when there are a normal number of receptors, patients feel more normal.

Whatever the mechanism, it is helpful to remember that if patients are suffering with persistent withdrawal symptoms after they detox off opiates, they may benefit from Naltrexone.

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