Table 3.

Adjunctive medications for critically ill patients receiving long-acting naltrexone requiring analgesia or anxiolysis

Medication	Indication	Considerations
Dexmedetomidine	Anxiolysis and analgesia	Dose may be limited by bradycardia and there is risk for withdrawal with prolonged infusion
Nonsteroidal antiinflammatory medications	Analgesia	Concern for adverse drug reactions and for acute renal injury
Acetaminophen	Analgesia	May need dose reduction with certain comorbidities, such as liver disease
Ketamine	Anxiolysis and analgesia	Limited evidence base in critically ill patients, and concern for increased risk of acute delirium in the ICU setting
Gabapentin, pregabalin, carbamazepine	Neuropathic pain and anxiolysis	Dose reduction required in renal failure and concern for medication interactions with carbamazepine
Dexamethasone	Antiinflammatory	Multiple adverse effects
Phenobarbital	Anxiolysis	Prolonged duration of action and potential for medication interactions via cytochrome P450 system
Benzodiazepines	Anxiolysis	Risk of delirium, prolonged ventilation, and paradoxical reactions
Propofol	Sedation and hypnosis	Commonly associated with hypotension

Definition of abbreviation: ICU = intensive care unit.