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      Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women.

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          Abstract

          Pregnant women with opioid use disorder can be treated with methadone, buprenorphine, or naltrexone to reduce opioid use and improve retention to treatment. In this review, we compare the pregnancy outcomes of methadone, buprenorphine, and naltrexone in clinical trials and discuss the potential behavioral and developmental effects of these agents seen in offspring in animal studies. Important clinical considerations in the management of opioid use disorder in pregnant women and their infants are also discussed. Outside of pregnancy, buprenorphine is used in combination with naloxone to reduce opioid abuse and diversion. During pregnancy, however, the use of buprenorphine as a single agent is preferred to prevent prenatal naloxone exposure. Both methadone and buprenorphine are widely used to treat opioid use disorder; however, compared with methadone, buprenorphine is associated with shorter treatment duration, less medication needed to treat neonatal abstinence syndrome (NAS) symptoms, and shorter hospitalizations for neonates. Despite being the standard of care, medication-assisted treatment with methadone or buprenorphine is still underused, making it apparent that more options are necessary. Naltrexone is not a first-line treatment primarily because both detoxification and an opioid-free period are required. More research is needed to determine naltrexone safety and benefits in pregnant women. Animal studies suggest that changes in pain sensitivity, developmental processes, and behavioral responses may occur in children born to mothers receiving methadone, buprenorphine, or naltrexone and is an area that warrants future studies. This article is protected by copyright. All rights reserved.

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          Author and article information

          Journal
          Pharmacotherapy
          Pharmacotherapy
          Wiley-Blackwell
          1875-9114
          0277-0008
          May 24 2017
          Affiliations
          [1 ] Associate Professor of Pharmacy Practice, Midwestern University Chicago College of Pharmacy.
          [2 ] Professor of Pharmacy Practice, Midwestern University Chicago College of Pharmacy.
          [3 ] Assistant Professor of Pharmacy Practice, University of Georgia College of Pharmacy.
          Article
          10.1002/phar.1958
          28543191

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