What is acamprosate? Acamprosate is used to help maintain sobriety in alcohol-dependent adults who no longer drink alcohol. acamprosate is used with behavioral therapy or counseling support to help prevent an urge to drink again. Acamprosate will not treat or prevent alcohol withdrawal symptoms. Acamprosate may not be as effective if you have not gone through detox and stopped drinking alcohol completely. This medicine is also unlikely to be effective in people who abuse drugs or other substances. Acamprosate may also be used for purposes not listed in this medication guide. Warnings Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies. Before taking this medicine You should not use acamprosate if you are allergic to it, or if you have severe kidney disease. Tell your doctor if you have ever had kidney problems. Some people have thoughts about suicide while taking acamprosate. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Tell your doctor if you are pregnant or breastfeeding. How should I take acamprosate? Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed. Start taking acamprosate as soon as possible after you have quit drinking. May be taken with or without food. If you routinely eat 3 meals daily, take the medicine at each meal. Swallow the tablet whole and do not crush, chew, or break it. Keep taking acamprosate as directed even if you relapse and drink alcohol. Tell your doctor about any alcohol you consume, no matter how much. Your treatment will also include counseling support and continued abstinence from alcohol. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. Get your prescription refilled before you run out of medicine completely. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking acamprosate? Follow your doctor's instructions about any restrictions on food, beverages, or activity. Acamprosate side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: severe anxiety or depression; mood or behavior changes; thoughts about suicide or hurting yourself; severe diarrhea; or kidney problems--swelling, urinating less, feeling tired or short of breath. Common side effects may include: anxiety, depressed mood; dizziness; sleep problems; pain, weakness; itching, sweating, tingling; nausea, diarrhea, gas, loss of appetite; or dry mouth. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   Acamprosate dosing information Usual Adult Dose for Alcohol Dependence: 666 mg orally 3 times a day Comments: -Doses should be taken with meals in patients who regularly eat 3 meals a day. -Treatment should begin as soon as possible after the withdrawal period (when the patient achieves abstinence) and should be maintained if the patient relapses. -This drug should be used as part of a comprehensive psychosocial treatment program. -Lower doses may be effective in some patients. Use: For the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation What other drugs will affect acamprosate? Other drugs may affect acamprosate, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

What is buprenorphine and naloxone? Buprenorphine and naloxone is a combination medicine used to treat opioid addiction. Buprenorphine and naloxone is not for use as a pain medication. Buprenorphine and naloxone may also be used for purposes not listed in this medication guide. Warnings MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Taking buprenorphine and naloxone during pregnancy may cause life-threatening withdrawal symptoms in the newborn. Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing. Before taking this medicine You should not use this medicine if you are allergic to buprenorphine or naloxone (Narcan). Tell your doctor if you have ever had: breathing problems, sleep apnea; enlarged prostate, urination problems; liver or kidney disease; abnormal curvature of the spine that affects breathing; problems with your gallbladder, adrenal gland, or thyroid; a head injury, brain tumor, or seizures; or alcoholism or drug addiction. If you use opioid medicine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on opioids may need medical treatment for several weeks. Ask a doctor before using opioid medicine if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby. How should I take buprenorphine and naloxone? Follow the directions on your prescription label and read all medication guides. Never use buprenorphine and naloxone in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of buprenorphine and naloxone. Never share opioid medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine in a place where others cannot get to it. Selling or giving away opioid medicine is against the law. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions. If you switch between medicines containing buprenorphine, you may not use the same dose for each one. Follow all directions carefully. Do not stop using buprenorphine and naloxone suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine. You will need frequent blood tests to check your liver function. All your medical care providers should know that you are being treated for opioid addiction, and that you take buprenorphine and naloxone. Make sure your family members know how to provide this information in case they need to speak for you during an emergency. Never crush or break a buprenorphine and naloxone pill to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death. Store this medicine in the foil pouch at room temperature, away from moisture and heat. Discard an empty pouch in a place children and pets cannot get to. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription. Do not keep leftover opioid medication. Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, remove any unused films from the foil pack and flush the films down the toilet. Throw the empty foil pack into the trash.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An opioid overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing. What should I avoid while taking buprenorphine and naloxone? Do not drink alcohol. Dangerous side effects or death could occur. Avoid driving or operating machinery until you know how buprenorphine and naloxone will affect you. Dizziness or severe drowsiness can cause falls, accidents, or severe injuries. Buprenorphine and naloxone side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Call your doctor at once or seek emergency medical attention if you have: weak or shallow breathing, breathing that stops during sleep; a light-headed feeling, like you might pass out; confusion, loss of coordination, extreme weakness; blurred vision, slurred speech; liver problems--upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); high levels of serotonin in the body--agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea; low cortisol levels--nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or opioid withdrawal symptoms--shivering, goose bumps, increased sweating, feeling hot or cold, runny nose, watery eyes, diarrhea, muscle pain. Serious breathing problems may be more likely in older adults and those who are debilitated or have wasting syndrome or chronic breathing disorders. Common side effects may include: dizziness, drowsiness, blurred vision, feeling drunk, trouble concentrating; withdrawal symptoms; tongue pain, redness or numbness inside your mouth; nausea, vomiting, constipation; headache, back pain; fast or pounding heartbeats, increased sweating; or sleep problems (insomnia). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect buprenorphine and naloxone? You may have breathing problems or withdrawal symptoms if you start or stop taking certain other medicines. Tell your doctor if you also use an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or medicine to treat HIV or hepatitis C. Opioid medication can interact with many other drugs and cause dangerous side effects or death. Be sure your doctor knows if you also use: cold or allergy medicines, bronchodilator asthma/COPD medication, or a diuretic ("water pill"); medicines for motion sickness, irritable bowel syndrome, or overactive bladder; other opioids--opioid pain medicine or prescription cough medicine; a sedative like Valium--diazepam, alprazolam, lorazepam, Xanax, Klonopin, Ativan, and others; drugs that make you sleepy or slow your breathing--a sleeping pill, muscle relaxer, medicine to treat mood disorders or mental illness; or drugs that affect serotonin levels in your body--a stimulant, or medicine for depression, Parkinson's disease, migraine headaches, serious infections, or nausea and vomiting. This list is not complete. Other drugs may affect buprenorphine and naloxone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.

What is buprenorphine and naloxone? Buprenorphine and naloxone is a combination medicine used to treat opioid addiction. Buprenorphine and naloxone is not for use as a pain medication. Buprenorphine and naloxone may also be used for purposes not listed in this medication guide. Warnings MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Taking buprenorphine and naloxone during pregnancy may cause life-threatening withdrawal symptoms in the newborn. Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing. Before taking this medicine You should not use this medicine if you are allergic to buprenorphine or naloxone (Narcan). Tell your doctor if you have ever had: breathing problems, sleep apnea; enlarged prostate, urination problems; liver or kidney disease; abnormal curvature of the spine that affects breathing; problems with your gallbladder, adrenal gland, or thyroid; a head injury, brain tumor, or seizures; or alcoholism or drug addiction. If you use opioid medicine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on opioids may need medical treatment for several weeks. Ask a doctor before using opioid medicine if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby. How should I take buprenorphine and naloxone? Follow the directions on your prescription label and read all medication guides. Never use buprenorphine and naloxone in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of buprenorphine and naloxone. Never share opioid medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine in a place where others cannot get to it. Selling or giving away opioid medicine is against the law. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions. If you switch between medicines containing buprenorphine, you may not use the same dose for each one. Follow all directions carefully. Do not stop using buprenorphine and naloxone suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine. You will need frequent blood tests to check your liver function. All your medical care providers should know that you are being treated for opioid addiction, and that you take buprenorphine and naloxone. Make sure your family members know how to provide this information in case they need to speak for you during an emergency. Never crush or break a buprenorphine and naloxone pill to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death. Store this medicine in the foil pouch at room temperature, away from moisture and heat. Discard an empty pouch in a place children and pets cannot get to. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription. Do not keep leftover opioid medication. Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, remove any unused films from the foil pack and flush the films down the toilet. Throw the empty foil pack into the trash.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An opioid overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing. What should I avoid while taking buprenorphine and naloxone? Do not drink alcohol. Dangerous side effects or death could occur. Avoid driving or operating machinery until you know how buprenorphine and naloxone will affect you. Dizziness or severe drowsiness can cause falls, accidents, or severe injuries. Buprenorphine and naloxone side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Call your doctor at once or seek emergency medical attention if you have: weak or shallow breathing, breathing that stops during sleep; a light-headed feeling, like you might pass out; confusion, loss of coordination, extreme weakness; blurred vision, slurred speech; liver problems--upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); high levels of serotonin in the body--agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea; low cortisol levels--nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or opioid withdrawal symptoms--shivering, goose bumps, increased sweating, feeling hot or cold, runny nose, watery eyes, diarrhea, muscle pain. Serious breathing problems may be more likely in older adults and those who are debilitated or have wasting syndrome or chronic breathing disorders. Common side effects may include: dizziness, drowsiness, blurred vision, feeling drunk, trouble concentrating; withdrawal symptoms; tongue pain, redness or numbness inside your mouth; nausea, vomiting, constipation; headache, back pain; fast or pounding heartbeats, increased sweating; or sleep problems (insomnia). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect buprenorphine and naloxone? You may have breathing problems or withdrawal symptoms if you start or stop taking certain other medicines. Tell your doctor if you also use an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or medicine to treat HIV or hepatitis C. Opioid medication can interact with many other drugs and cause dangerous side effects or death. Be sure your doctor knows if you also use: cold or allergy medicines, bronchodilator asthma/COPD medication, or a diuretic ("water pill"); medicines for motion sickness, irritable bowel syndrome, or overactive bladder; other opioids--opioid pain medicine or prescription cough medicine; a sedative like Valium--diazepam, alprazolam, lorazepam, Xanax, Klonopin, Ativan, and others; drugs that make you sleepy or slow your breathing--a sleeping pill, muscle relaxer, medicine to treat mood disorders or mental illness; or drugs that affect serotonin levels in your body--a stimulant, or medicine for depression, Parkinson's disease, migraine headaches, serious infections, or nausea and vomiting. This list is not complete. Other drugs may affect buprenorphine and naloxone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.

What is naltrexone? Naltrexone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. An opioid is sometimes called a narcotic. Vivitrol is used as part of a treatment program for drug or alcohol dependence. Naltrexone injection is used to prevent relapse in adults who became dependent on opioid medicine and then stopped using it. Naltrexone can help keep you from feeling a "need" to use the opioid. Naltrexone injection is also used to treat alcoholism by reducing your urge to drink alcohol. This may help you drink less or stop drinking altogether. You should not be drinking at the time you receive your first injection. Naltrexone is not a permanent cure for drug addiction or alcoholism. Warnings You should be treated with naltrexone only if you have not recently used: any opioid medicine, buprenorphine, methadone, or medicine to treat a cold, cough, diarrhea, or pain. Using these medicines in the 7 to 14 days before starting naltrexone can cause sudden opioid withdrawal symptoms. Do not use opioid medication, heroin, or other street drugs while you are receiving this medicine. Doing so could result in dangerous effects, including coma and death. Call your doctor if you have ongoing or worsening pain, redness, itching, bruising, swelling, or a hard lump where the medicine was injected. Naltrexone can harm your liver. Tell your doctor if you have upper stomach pain, dark urine, or yellowing in the whites of your eyes. After receiving naltrexone, your body will be more sensitive to opioids if you use an opioid medicine in the future. Using the same amount you used before could lead to overdose or death. Before taking this medicine You should not receive a naltrexone injection if you still use opioid medicine, or you could have sudden and severe withdrawal symptoms. You should not be treated with naltrexone if you are allergic to it, or if: you are currently addicted to opioids; you are having withdrawal symptoms from opioid addiction; you have used any opioid medicine within the past 7 to 14 days (including fentanyl, Vicodin, OxyContin, and many others); you have used methadone or buprenorphine (Subutex, Butrans, Suboxone, Zubsolv) in the past 14 days; or you have used any medicine to treat a cold, cough, diarrhea, or pain in the past 7 to 14 days. To make sure naltrexone is safe for you, tell your doctor if you have ever had: liver disease; kidney disease; or bleeding problems such as hemophilia. Tell your doctor if you are pregnant or breastfeeding. It is not known whether naltrexone will harm an unborn baby. However, if you use opioid medicine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on opioids may need medical treatment for several weeks. How is naltrexone given? Naltrexone is injected into a muscle. This injection is usually given once a month (every 4 weeks) and can be given only by a healthcare professional. Get your naltrexone injection regularly to get the most benefit. You may notice pain, redness, itching, bruising, swelling, or a hard lump where the medicine was injected. Call your doctor if you have this type of reaction, especially if it gets worse or does not clear up within 2 weeks. Naltrexone injections are only part of a complete treatment program that may also include additional forms of counseling and/or monitoring. Follow your doctor's instructions very closely. In case of emergency, wear or carry medical identification to let others know you are using this medicine. After using naltrexone, your body will be more sensitive to opioids. If you use an opioid medicine in the future, you will need to use less than before naltrexone treatment. Using the same amount you used before could lead to overdose or death. Dosing information Usual Adult Dose for Alcohol Dependence: Injection: 380 mg intramuscularly every 4 weeks/once a month Usual Adult Dose for Opiate Addiction: Injection: 380 mg intramuscularly every 4 weeks/once a month Comments: -There is no data specifically addressing switching from buprenorphine or methadone to naltrexone, however some patients have reported severe manifestations of precipitated withdrawal when switched from an opioid agonist to opioid antagonist therapy. -Patients switching from buprenorphine or methadone may be vulnerable to precipitated withdrawal for up to 2 weeks. -Be prepared to manage withdrawal symptomatically with non-opioid medications. -This drug is of value only as a part of a comprehensive management plan that includes measures to ensure the patient takes this medication. Use(s): Blockade of the effects of exogenously administered opioids   What happens if I miss a dose? Call your doctor for instructions if you miss an appointment for your injection. What happens if I overdose? Since this injection is given by a healthcare professional in a medical setting, an overdose is unlikely to occur. However, overdose symptoms may include nausea, stomach pain, drowsiness, dizziness, or a reaction where an injection was given (such as severe pain or skin changes). What should I avoid while using naltrexone? Do not use opioid medication, heroin, or other street drugs while you are receiving naltrexone. Once naltrexone is injected, it cannot be removed from your body. Never try to overcome the effects of naltrexone by taking large doses of opioids. Doing so could result in dangerous effects, including coma and death. Ask your doctor before using any medicine to treat a cold, cough, diarrhea, or pain. These medicines may contain opioids and may not work as well while you are using this medicine. Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Naltrexone side effects Get emergency medical help if you have signs of an allergic reaction to naltrexone: hives; chest pain, wheezing, difficult breathing; feeling light-headed; swelling of your face, lips, tongue, or throat. Using opioid medicine while you are receiving this medicine could stimulate opioid withdrawal symptoms. Common withdrawal symptoms are yawning, sweating, fever, stomach pain, vomiting, diarrhea, watery eyes, runny nose, goose bumps, body aches, shaking, muscle twitching, trouble sleeping, and feeling restless or anxious. Call your doctor at once if you have: weak or shallow breathing; new or worsening cough, wheezing, trouble breathing; severe pain, swelling, blistering, skin changes, a dark scab, or a hard lump where the medicine was injected; liver problems - stomach pain (upper right side), dark urine, tiredness, jaundice (yellowing of the skin or eyes); or symptoms of depression - unusual mood or behavior changes, loss of interest in things you once enjoyed, crying, new sleep problems, thoughts about hurting yourself. You may feel nauseated the first time you receive this medicine. You may also have a headache, tiredness, joint and muscle pain, loss of appetite, and vomiting. Common naltrexone side effects may include: nausea, vomiting, loss of appetite; joint pain, muscle cramps; dizziness, drowsiness; sleep problems (insomnia); tooth pain; or cold symptoms such as stuffy nose, sneezing, sore throat. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect naltrexone? Other drugs may interact with naltrexone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.