那曲酮

那曲酮
臨床資料
讀音	/ˌnælˈtrɛksoʊn/
商品名（英語：Drug nomenclature）	Revia、Vivitrol、Depade、其它
其他名稱	EN-1639A; UM-792; ALKS-6428; N-cyclopropylmethylnoroxymorphone; N-cyclopropylmethyl-14-hydroxydihydromorphinone; 17-(cyclopropylmethyl)-4,5α-epoxy-3,14-dihydroxymorphinan-6-one
AHFS/Drugs.com	Monograph
MedlinePlus	a685041
核准狀況	美 DailyMed: Naltrexone;
懷孕分級	澳: B3 ; ;
給藥途徑	口服給藥, 肌肉注射, 皮下植入器（英語：subcutaneous implant）
ATC碼	N07BB04 (WHO) ;
法律規範狀態
法律規範	澳：限醫生處方（S4）; 加：處方藥（℞-only）; 英：處方藥（℞-only） (POM); 美：處方藥（℞-only）; 處方藥（℞-only）;
藥物動力學數據
生物利用度	5–60%
血漿蛋白結合率	20%
藥物代謝	肝臟（非-CYP450）
代謝產物	6β-Naltrexol（英語：6β-Naltrexol）、其它
藥效起始時間（英語：Onset of action）	30 分鐘
生物半衰期	口服 (Revia):; • Naltrexone: 4 小時; • 6β-Naltrexol（英語：6β-Naltrexol）: 13 小時; 口服 (Contrave):; • Naltrexone: 5 小時; 肌肉 (Vivitrol):; • Naltrexone: 5–10 天; • 6β-Naltrexol: 5–10 天
作用時間	>72 小時
排泄途徑	尿
識別資訊
	IUPAC命名法 (4R,4aS,7aR,12bS)-3-(cyclopropylmethyl)-4a,9-dihydroxy-2,4,5,6,7a,13-hexahydro-1H-4,12-methanobenzofuro[3,2-e]isoquinoline-7-one; ;
CAS號	16590-41-3
PubChem CID	5360515;
IUPHAR/BPS	1639;
DrugBank	DB00704 ;
ChemSpider	4514524 ;
UNII	5S6W795CQM;
KEGG	D05113 ;
ChEBI	CHEBI:7465 ;
ChEMBL	ChEMBL19019 ;
CompTox Dashboard（英語：CompTox Chemicals Dashboard） (EPA)	DTXSID4046313 ;
ECHA InfoCard	100.036.939
化學資訊
化學式	C20H23NO4
摩爾質量	341.41 g·mol−1
3D模型（JSmol（英語：JSmol））	交互式圖像;
熔點	169 °C（336 °F）
	SMILES O=C4[C@@H]5Oc1c2c(ccc1O)C[C@H]3N(CC[C@]25[C@@]3(O)CC4)CC6CC6;
	InChI InChI=1S/C20H23NO4/c22-13-4-3-12-9-15-20(24)6-5-14(23)18-19(20,16(12)17(13)25-18)7-8-21(15)10-11-1-2-11/h3-4,11,15,18,22,24H,1-2,5-10H2/t15-,18+,19+,20-/m1/s1 ; Key:DQCKKXVULJGBQN-XFWGSAIBSA-N ;

納曲酮（Naltrexone，同時有 ReVia 和 Vivitrol 兩個商品名）主要用於治療酒精或阿片類藥物依賴的藥物^[7]。阿片類藥物依賴者在戒毒前不應服用納曲酮^[7]。有口服或肌肉注射兩者劑型可使用^[7]。效果在 30 分鐘內開始出現^[7]。不過，對阿片類藥物的渴望可能需要幾周的時間才能消失^[7]。

副作用可能包括睡眠困難、焦慮、噁心和頭痛^[7]。對於仍在使用阿片類藥物的患者，可能會出現阿片類藥物戒斷症狀^[7]。不建議肝功能衰竭的患者使用^[7]。目前還不清楚懷孕期間使用是否安全^[7] ^[12]。納曲酮是一種類阿片拮抗劑（英語：opioid antagonist），可以阻斷類阿片（包括體內和體外）的作用^[7]。

納曲酮於 1965 年首次製造，並於 1984 年在美國取得醫療使用許可^[7] ^[13]。它被列入世界衛生組織基本藥物清單^[14]。在 2019 年，美國的批發成本約為每天（英語：defined daily dose）0.80 美元^[15]。緩釋型注射藥劑每月花費約 1,267 美元（每天 41 美元）^[15]。納曲酮，即納曲酮/安非他酮（英語：naltrexone/bupropion），也用於治療肥胖症^[16]。

參考文獻

^ Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017. Therapeutic Goods Administration (TGA). 21 June 2022 [30 March 2024]. （原始內容存檔於2023-07-06）.
^ ^2.0 ^2.1 ^2.2 ^2.3 Revia (naltrexone hydrochloride tablets USP50 mgOpioid Antagonist. DailyMed. 24 April 2015 [13 June 2022]. （原始內容存檔於14 June 2022）.
^ ^3.0 ^3.1 Contrave Extended-Release – naltrexone hydrochloride and bupropion hydrochloride tablet, extended release. DailyMed. 4 November 2021 [13 June 2022]. （原始內容存檔於4 June 2020）.
^ ^4.0 ^4.1 Vivitrol- naltrexone kit. DailyMed. 10 March 2021 [13 June 2022]. （原始內容存檔於30 May 2022）.
^ ^5.0 ^5.1 ^5.2 ^5.3 Gonzalez JP, Brogden RN. Naltrexone. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the management of opioid dependence. Drugs. March 1988, 35 (3): 192–213. PMID 2836152. S2CID 195697174. doi:10.2165/00003495-198835030-00002.
^ Lee MW, Fujioka K. Naltrexone for the treatment of obesity: review and update. Expert Opinion on Pharmacotherapy. August 2009, 10 (11): 1841–1845. CiteSeerX 10.1.1.496.9477  . PMID 19537999. S2CID 207477935. doi:10.1517/14656560903048959.
^ ^7.00 ^7.01 ^7.02 ^7.03 ^7.04 ^7.05 ^7.06 ^7.07 ^7.08 ^7.09 ^7.10 ^7.11 Naltrexone Monograph for Professionals - Drugs.com. Drugs.com. American Society of Health-System Pharmacists. [9 November 2017]. （原始內容存檔於9 November 2017）.
^ Colasanti A, Lingford-Hughes A, Nutt D. Opioids Neuroimaging. Miller PM (編). Biological Research on Addiction. Comprehensive Addictive Behaviors and Disorders 2. Elsevier. 2013: 675–687. ISBN 9780123983350. doi:10.1016/B978-0-12-398335-0.00066-2.
^ Lee MC, Wagner HN, Tanada S, Frost JJ, Bice AN, Dannals RF. Duration of occupancy of opiate receptors by naltrexone. Journal of Nuclear Medicine. July 1988, 29 (7): 1207–1211 [29 October 2021]. PMID 2839637. （原始內容存檔於29 October 2021）.
^ Sevarino KA, Kosten TR. Naltrexone for Initiation and Maintenance of Opiate Abstinence. Dean RL, Bilsky EJ, Negus SS (編). Opiate Receptors and Antagonists. Humana Press. 2009: 227–245. ISBN 978-1-58829-881-2. doi:10.1007/978-1-59745-197-0_12.
^ Anvisa. RDC Nº 784 – Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control]. Diário Oficial da União（英語：Diário Oficial da União）. 31 March 2023 (4 April 2023) [16 August 2023]. （原始內容存檔於3 August 2023）（巴西葡萄牙語）.
^ Tran TH, Griffin BL, Stone RH, Vest KM, Todd TJ. Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women. Pharmacotherapy. July 2017, 37 (7): 824–839. PMID 28543191. doi:10.1002/phar.1958.
^ Sadock, Benjamin J.; Sadock, Virginia A.; Sussman, Norman. Kaplan & Sadock's Pocket Handbook of Psychiatric Drug Treatment. Lippincott Williams & Wilkins. 2012: 265. ISBN 9781451154467. （原始內容存檔於2017-12-05）（英語）.
^ World Health Organization. The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. 2023. WHO/MHP/HPS/EML/2023.02.
^ ^15.0 ^15.1 NADAC as of 2019-07-17 | Data.Medicaid.gov. Centers for Medicare and Medicaid Services. [16 July 2019]. （原始內容存檔於2019-07-16）（英語）.
^ Naltrexone/bupropion for obesity. Drug and Therapeutics Bulletin. November 2017, 55 (11): 126–129. PMID 29117992. doi:10.1136/dtb.2017.11.0550.

[1] Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017. Therapeutic Goods Administration (TGA). 21 June 2022 [30 March 2024]. （原始內容存檔於2023-07-06）.

[ReviaLabel-2] 2.0 ^2.1 ^2.2 ^2.3 Revia (naltrexone hydrochloride tablets USP50 mgOpioid Antagonist. DailyMed. 24 April 2015 [13 June 2022]. （原始內容存檔於14 June 2022）.

[ContraveLabel-3] 3.0 ^3.1 Contrave Extended-Release – naltrexone hydrochloride and bupropion hydrochloride tablet, extended release. DailyMed. 4 November 2021 [13 June 2022]. （原始內容存檔於4 June 2020）.

[VivitrolLabel-4] 4.0 ^4.1 Vivitrol- naltrexone kit. DailyMed. 10 March 2021 [13 June 2022]. （原始內容存檔於30 May 2022）.

[pmid2836152-5] 5.0 ^5.1 ^5.2 ^5.3 Gonzalez JP, Brogden RN. Naltrexone. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the management of opioid dependence. Drugs. March 1988, 35 (3): 192–213. PMID 2836152. S2CID 195697174. doi:10.2165/00003495-198835030-00002.

[pmid19537999-6] Lee MW, Fujioka K. Naltrexone for the treatment of obesity: review and update. Expert Opinion on Pharmacotherapy. August 2009, 10 (11): 1841–1845. CiteSeerX 10.1.1.496.9477  . PMID 19537999. S2CID 207477935. doi:10.1517/14656560903048959.

[AHFS2017-7] 7.00 ^7.01 ^7.02 ^7.03 ^7.04 ^7.05 ^7.06 ^7.07 ^7.08 ^7.09 ^7.10 ^7.11 Naltrexone Monograph for Professionals - Drugs.com. Drugs.com. American Society of Health-System Pharmacists. [9 November 2017]. （原始內容存檔於9 November 2017）.

[ColasantiLingford-HughesNutt2013-8] Colasanti A, Lingford-Hughes A, Nutt D. Opioids Neuroimaging. Miller PM (編). Biological Research on Addiction. Comprehensive Addictive Behaviors and Disorders 2. Elsevier. 2013: 675–687. ISBN 9780123983350. doi:10.1016/B978-0-12-398335-0.00066-2.

[pmid2839637-9] Lee MC, Wagner HN, Tanada S, Frost JJ, Bice AN, Dannals RF. Duration of occupancy of opiate receptors by naltrexone. Journal of Nuclear Medicine. July 1988, 29 (7): 1207–1211 [29 October 2021]. PMID 2839637. （原始內容存檔於29 October 2021）.

[SevarinoKosten2009-10] Sevarino KA, Kosten TR. Naltrexone for Initiation and Maintenance of Opiate Abstinence. Dean RL, Bilsky EJ, Negus SS (編). Opiate Receptors and Antagonists. Humana Press. 2009: 227–245. ISBN 978-1-58829-881-2. doi:10.1007/978-1-59745-197-0_12.

[11] Anvisa. RDC Nº 784 – Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control]. Diário Oficial da União（英語：Diário Oficial da União）. 31 March 2023 (4 April 2023) [16 August 2023]. （原始內容存檔於3 August 2023）（巴西葡萄牙語）.

[12] Tran TH, Griffin BL, Stone RH, Vest KM, Todd TJ. Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women. Pharmacotherapy. July 2017, 37 (7): 824–839. PMID 28543191. doi:10.1002/phar.1958.

[Sad2012-13] Sadock, Benjamin J.; Sadock, Virginia A.; Sussman, Norman. Kaplan & Sadock's Pocket Handbook of Psychiatric Drug Treatment. Lippincott Williams & Wilkins. 2012: 265. ISBN 9781451154467. （原始內容存檔於2017-12-05）（英語）.

[WHO23rd-14] World Health Organization. The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. 2023. WHO/MHP/HPS/EML/2023.02.

[NADAC2019-15] 15.0 ^15.1 NADAC as of 2019-07-17 | Data.Medicaid.gov. Centers for Medicare and Medicaid Services. [16 July 2019]. （原始內容存檔於2019-07-16）（英語）.

[16] Naltrexone/bupropion for obesity. Drug and Therapeutics Bulletin. November 2017, 55 (11): 126–129. PMID 29117992. doi:10.1136/dtb.2017.11.0550.

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