Retin-A 0.025% (Naltrexone)
Class and Category of Drug
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Chemical class: Thebaine derivative
Therapeutic class: Opioid antagonist
Pregnancy category: C
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Drug Indications and Dosages
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To treat opioid dependence
Tablets
Adults. Initial: 25 mg, repeated within 1 hr, if needed and if no withdrawal symptoms occur. Maintenance: 50 to 150 mg daily or 350 mg/wk by intermittent dosing regimen.
As adjunct to treat alcoholism
Tablets
Adults. 50 mg daily (up to 100 mg daily for some patients) for 12 wk.
I.M. Injection
Adults. 380 mg every 4 wk or once monthly-
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Contraindications of Drug
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Acute hepatitis, acute opioid withdrawal, concurrent use of opioid analgesics (including opioid agonists, such as methadone or levoalpha-acetyl-methadol [LAAM]), failure of naloxone challenge test, hepatic failure, hypersensitivity to naltrexone or its components, opioid dependence, positive urine screen for opioids
Generic Drug Interactions
Drugs
opioid analgesics: Reversal of analgesic and adverse effects of these drugs, possibly withdrawal symptoms in opioid-dependent patients
thioridazine: Increased somnolence and lethargy
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Drugs Adverse Reactions
Central Nervous System: Anxiety, chills, confusion, depression, dizziness, fatigue, fever, hallucinations, headache, insomnia, irritability, nervousness, restlessness, somnolence, suicidal ideation, syncope
Cardiovascular: Chest pain, edema, hypertension, tachycardia
Eyes, Ears, Nose, And Throat: Blurred vision, burning eyes, conjunctivitis, dry mouth, eyelid swelling, hoarseness, pharyngitis, rhinitis, sneezing, tinnitus
Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastrointestinal ulceration, hepatotoxicity with excessive doses, nausea, thirst, vomiting
Genitourinary: Difficult ejaculation, urinary frequency
Musculoskeletal: Arthralgia, back pain or stiffness, joint sitffness, muscle cramps, myalgia
* For 50 mg; 48 hr for 100 mg; 72 hr for 150 mg.
Respiratory: Cough, dyspnea, eosinophilic pneumonia, upper respiratory tract infection
Skin: Pruritus, rash
Other: Injection site reactions, such as pain,tenderness, induration, swelling, erythema, pruritus
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Nursing Considerations for Generic Drugs
• Use naltrexone cautiously in patients with severe renal impairment, thrombocytopenia, hemophilia, or severe hepatic failure.
• To avoid withdrawal symptoms, wait 7 to 10 days after last opioid dose, as prescribed, before starting naltrexone. Because urine testing isn't always conclusive, prepare patient for naloxone challenge test if there are any doubts about patient's abstinence.
• Give oral drug with food or antacids to decrease adverse gastrointestinal reactions.
• Dilute parenteral form using only diluent supplied in carton. Inject in gluteal muscle using only needle supplied in carton. Don't substitute any components for components in carton. Store entire dose pack in refrigerator; unrefrigerated drug can be stored at room temperature for no more than 7 days.
• Inspect injection site for reactions, such as tenderness, induration, swelling, or redness. Ask if patient feels pain or itching at the site. Report any such findings to prescriber because abscesses and site necrosis may occur and require surgical intervention.
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Tretinoin
Preparations
International Brand Drug Names
The information about drugs (tablets, pills, capsules, creams, solution, nasal spray, inhaler) around the world.
British Pharmacopoeia, 2008 edition: Tretinoin Gel; Tretinoin Solution;
The United States Pharmacopeia 31, 2008: Tretinoin Cream; Tretinoin Gel; Tretinoin Topical Solution.
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