Table 5.
Management of MOUD during acute painful episodes.
| Medication | Mechanism of Action | Acute Pain Strategies |
|---|---|---|
| Buprenorphine | Partial mu-opioid agonist, kappa-opioid antagonist | Continue home regimen; Split home regimen into TID dosing for same TDD |
| Methadone | Full mu-opioid agonist, NMDA antagonist | Continue home regimen; Split home regimen into TID dosing for same TDD |
| Naltrexone (IM) | Mu-opioid antagonist | Stop IM dose 30 days prior to painful procedure and until patient has been opioid-free for 3 days afterward; Multimodal therapies to treat painful crisis, consider ketamine and regional anesthesia |
| Naltrexone (PO) | Mu-opioid antagonist | Stop therapy 72 h prior to painful and until patient has been opioid-free for 3 days afterward; Multimodal therapies to treat painful crisis, consider ketamine and regional anesthesia |