Table 1 Comparative information for patients to make a decision
| Â | Methadone | Buprenorphine | Oral naltrexone | Extended release naltrexone |
|---|---|---|---|---|
Route | Oral daily | Sublingual daily or every other day | Oral daily or three times per week | Intramuscular injections every 28Â days |
Constipation | ++ | ++ | − | − |
Sexual dysfunction | ++ | + | − | − |
Physical dependence | ++ | ++ | − | − |
Sweating | ++ (rare) | − | − | − |
Starting/Stopping | No lead-in abstinence Gradual taper | Either lead-in abstinence or no lead-in abstinence if in opioid withdrawal at time of induction Gradual taper | Lead-in abstinence (2–10 days) No taper | Lead-in abstinence (2–10 days) No taper |
Weight gain | − | − | − | − |
Sedation | ± | ± | − | − |
Bone/joint pain | − | − | − | − |
Dental problems | − | − | − | − |
Opiate effect | ++ | + | − | − |
Interferes with pain management using opiates | − | ± | + | + |
Drug interactions | HIV medications Phenytoin Rifampin Carbamazepine Benzodiazepines Alcohol | Atazanavir Benzodiazepines Alcohol | Opioid analgesics | Opioid analgesics- |
Risk of overdose | + | ± (with benzodiazepines) | − | − |