Drugs for Substance Use Disorders

Psychiatric

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Examples

methadone, buprenorphine, naltrexone (opioid use)disulfiram, naltrexone, acamprosate (alcohol use)varenicline, nicotine replacement (tobacco use)

Prefix / Suffix: No consistent suffix

Physiology

Substance use disorders involve dysregulation of reward pathways. Treatment uses agonists, antagonists, or aversive agents to support recovery.

Mechanism of Action

Methadone/buprenorphine: opioid agonists that reduce cravings and withdrawal. Naltrexone: opioid antagonist that blocks reward. Disulfiram: blocks alcohol metabolism causing aversive reaction. Acamprosate: modulates glutamate. Varenicline: partial nicotinic receptor agonist.

Indications

Opioid use disorder (methadone, buprenorphine, naltrexone)
Alcohol use disorder (disulfiram, naltrexone, acamprosate)
Tobacco use disorder (varenicline, nicotine replacement, bupropion)

Side Effects / Adverse Effects

Methadone: respiratory depression, QT prolongation, constipation
Buprenorphine: respiratory depression (less than methadone), precipitated withdrawal
Naltrexone: hepatotoxicity, GI upset, precipitates opioid withdrawal
Disulfiram: severe reaction with alcohol (flushing, nausea, hypotension)
Varenicline: nausea, neuropsychiatric effects (mood changes)

Contraindications

Naltrexone: current opioid use (precipitates withdrawal)
Disulfiram: recent alcohol use (within 12 hours)
Methadone/buprenorphine: severe respiratory disease
Varenicline: severe psychiatric history (caution)

Nursing Considerations

Methadone: dispensed only through certified opioid treatment programs; monitor ECG (QT prolongation)
Buprenorphine: wait until patient is in mild-moderate withdrawal before first dose
Naltrexone: must be opioid-free for 7–10 days before starting
Disulfiram: educate to avoid all alcohol — even mouthwash, cooking wine, OTC cough syrups
Monitor liver function (naltrexone, disulfiram)
Combine medication with counseling and support groups for best outcomes
Varenicline: monitor for mood changes, suicidal ideation
Educate that medications support recovery but are not a cure

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.