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Prior to naltrexone initiation: Ask about opioid use history or if currently on buprenorphine or methadone Administer a 0.4 mg IV naloxone challenge dose Will help to determine if naltrexone would precipitate withdrawal If no precipitated withdrawal occurs, proceed with treatment Start naltrexone treatment: Oral: Start with 50 mg PO naltrexone Injectable: Start with 380 mg IM naltrexone Discharge planning: If PO naltrexone is given, then discharge the patient with a prescription for up to 30 days (50 mg daily)

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The goal: to maximize therapeutic potential through synergy between components

If you cant use Ozempic for medical reasons, you might consider compounded semaglutide