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• If no naltrexone combined with bupropion contrave buy naltrexone spain buy vivitrol online naltrexone change in COWS administer additional 0 . 8 mg (2 cc) to the other deltoid and monitor for additional 20 minutes • Test is considered positive if there is a COWS increase of 2 or more from the pre-injection buy revia cheap low dose naltrexone tablets naltrexone pills for weight loss vivitrol medical score • In case of positive challenge, do not administer XR-naltrexone, wait 1-2 days and repeat the challenge • If the test is negative, proceed with the XR-Naltrexone injection .
) Challenge Procedure • Obtain baseline COWS; if 4 or less proceed with the challenge • Administer naltrexone 25 naltrexone mg p . naltrexone Naltrexone (p .
1 buy low dose naltrexone india naltrexone uk pharmacy revia tablets samsung naltrexone uk nhs mg every 4-6 hours (monitor for orthostatic hypertension, hold if SBP<100) • Clonazepam 0 . and observe for 90 minutes, if COWS increase is less than 2 proceed with XR-naltrexone injection • In case of positive challenge, treat withdrawal with adjunctive medications and reschedule injection for next day • Administer XR-naltrexone (no need for repeated challenge the next day unless naltrexone there was a new episode of use) Adjunctive Medications to treat Opioid Withdrawal • Clonidine 0 . 5 mg every 6-8 hours • Trazodone 100 mg at night for insomnia Buprenorphine-assisted withdrawal management • Wait until the patient is in withdrawal (COWS > 6) and administer buprenorphine (4 mg bid on Day 1) • Administer adjunctive medications as needed to alleviate residual withdrawal • Continue adjunctive medication for at least 7 days after the last day of buprenorphine • Perform naloxone/naltrexone challenge before administering naltrexone XR-naltrexone * The suggested protocols are off-label, based on the expert consensus and do not reflect the official position of SAMHSA .

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