Table 1 Comparative information for patients to make a decision
| Methadone | Buprenorphine | Oral naltrexone | Extended release naltrexone | |
|---|---|---|---|---|
| Route | Oral daily | Sublingual daily or every other day | Oral daily or three times per week | Intramuscular injections every 28 days |
| Constipation | ++ | ++ | − | − |
| Sexual dysfunction | ++ | + | − | − |
| Physical dependence | ++ | ++ | − | − |
| Sweating | ++ (rare) | − | − | − |
| Starting/Stopping | No lead-in abstinence Gradual taper | Either lead-in abstinence or no lead-in abstinence if in opioid withdrawal at time of induction Gradual taper | Lead-in abstinence (2–10 days) No taper | Lead-in abstinence (2–10 days) No taper |
| Weight gain | − | − | − | − |
| Sedation | ± | ± | − | − |
| Bone/joint pain | − | − | − | − |
| Dental problems | − | − | − | − |
| Opiate effect | ++ | + | − | − |
| Interferes with pain management using opiates | − | ± | + | + |
| Drug interactions | HIV medications Phenytoin Rifampin Carbamazepine Benzodiazepines Alcohol | Atazanavir Benzodiazepines Alcohol | Opioid analgesics | Opioid analgesics- |
| Risk of overdose | + | ± (with benzodiazepines) | − | − |