Naltrexone is a narcotic and is similar to suboxone for drug addiction and it does pretty much the same thing. So IMHO, you are just switching one addiction for another! It's probably a case of using the lessor of two evils.

Also, like other narcotics, you build up a tolerance over time so have to keep having the dosage increased. This is how it works, when the opiod binds to the opiod receptors in the brain. The neurons send out a massive amount of dopamine which is the "feel good" chemical. Now the brain is not designed that way so it begins dropping receptors from the neurons in an attept to balance itself out and this is called...building a tolerance.

Now for some people naltrexone may be the only option but not until all other options are given a chance to work.

To my knowledge there is no cure for alcoholism. It can be controlled but not cured.

I hope anyone thinking about using naltrexone exausts all other options before going the naltrexon route because once on it, you will be on it for life!

Good Luck!

I took it years ago the first time I quit. It helps with cravings and it decreases the enjoyment we get from alcohol. It is not a cure, it is a tool to help you stop. It does help, but not a cure. Sly

Naltrexone is not even remoteley close to Suboxone. Suboxone is a synthetic opiate made to come off of methadone and other opiates. Naltrexone is used for alcohol cravings. Relatively side effect free.

#3 my apologies! You're right. Naltrexone is a blocking drug but suboxone is a substitute however, you can still become addicted to it over time. Naltrexone is also used in treatment in recovering drug addicts as well.

God Bless!

Don't you think that if it really worked there would be more fuss about it?

Precisely. AA would be finished and no need for this support group. Most alcoholics would prefer to drink like normies and would jump at the chance to do so if it was as simple as a pill. Not for me...abstaining is my only cure.

I read an article about that very subject... We have antI-craving drugs but treatment professionals seem to be blind to them. They are really quite effective. I'm going back on it next time I see my dr. I am only 2 days sober after a long period of sobriety. I'll take all the help I can get. They really help me with cravings. Sly

Bob, naltrexone is not a narcotic and it is not addictive. You do not build up a tolerance for it. You are not switching one addiction for another when you take it.

It is a viable treatment that has been proven in multiple studies to be effective.

That said, it is not a cure. It is only one part of treatment and it is recommended to be used in conjunction with counseling or other therapies.

i quit without it. But I would take it in a heartbeat if I thought it would help me, just like I would undergo chemo for cancer.

I should explain, that didn't sound right...I have been sober for 10 out of the last 13 years. My longest straight run of sobriety was 7 years. For the last 5 years a year or 2 here and there. I'm just ready to completely done with it!

I've no experience of this drug but maybe a fact sheet might be helpful

http://pubs.niaaa.nih.gov/publications/combine/appendixC.htm

Exjerseygirl - I agree that the best way to treat any addiction is to go about it from as many angles as possible; so I do believe (and the book also states this I think) that it is best to do it in conjunction with support groups, etc.

To those who think it's not worth considering because there isn't enough fuss about it - I think the problem is that a lot of the times it is prescribed the mechanism isn't well known and so the docs prescribe it saying you should quit drinking and then take it. It won't work if you do this (which is why people that have already quit should just keep doing what they are currently doing). This is for people who can't quit on their own and the treatment only works if you are still drinking.

Just because something isn't wildly popular doesn't mean it's not worth looking into. Everyone is different and different things work for different people. If you already quit with AA, there isn't a need for this drug for you........it's for people that can't do that.

NALTREXONE

Brands Revia (oral)
Vivitrol (injection)
see index for additional brand names
Generic? Yes (not injection or solution)
Class
Alcohol dependence treatment; mu opioid
receptor antagonist
Commonly Prescribed for
(bold for FDA approved)
Alcohol dependence
Blockade of effects of exogenously
administered opioids (oral)
Prevention of relapse to opioid
dependence (injection)
How the Drug Works
Blocks mu opioid receptors, preventing
exogenous opioids from binding there and
thus preventing the pleasurable effects of
opioid consumption
Reduces alcohol consumption through
modulation of opioid systems, thereby
reducing the reinforcing effects of alcohol
How Long Until It Works
Can begin working within a few days but
maximum effects may not be seen for a
few weeks
If It Works
Reduces alcohol and opioid consumption
by diminishing their reinforcing properties
(rewarding effects, cravings)
If It Doesnt Work
Evaluate for and address contributing
factors
Consider switching to another agent
Consider augmenting with acamprosate
Best Augmenting Combos
for Partial Response orTreatment Resistance
Acamprosate
Augmentation therapy may be more
effective than monotherapy
Augmentation with behavioral, education,
and/or supportive therapy in groups or as
an individual is probably key to successful
treatment

Tests

Urine screen for opioids and/or naloxone
challenge test prior to initiating treatment
for opioid use
None for use in treating alcohol dependence,
although baseline liver function testing,
usually obtained anyway for managing
alcohol dependence, may be useful

SIDE EFFECTS

How Drug Causes Side Effects
Blockade of mu opioid receptors
Notable Side Effects
Nausea, vomiting, decreased appetite
Dizziness, dysphoria, anxiety
Injection site reactions (pain, tenderness,
pruritis, induration, swelling, erythema,
or bruising); in some cases injection site
reactions may be very severe
Life-Threatening or
Dangerous Side Effects
Eosinophilic pneumonia
Hepatocellular injury (at excessive doses)
Severe injection site reactions requiring
surgery
Weight Gain
Reported but not expected
Sedation
Occurs in significant minority
What to Do About Side Effects
Wait
Adjust dose
If side effects persist, discontinue use
Best Augmenting Agents for Side
Effects
Dose reduction or switching to another
agent may be more effective since most
side effects cannot be improved with an
augmenting agent

Usual Dosage Range

Oral: 50 mg/day or 100 mg on Mon and
Wed and 150 mg on Fri
Injection: 380 mg every 4 weeks
Dosage Forms
Tablet 25 mg, 50 mg, 100 mg
Oral solution 12 mg/0.6 mL
Intramuscular formulation 380 mg/vial
How to Dose
For treating alcohol dependence (oral):
recommended dose is 50 mg/day; titration
is not required
For treating alcohol dependence (injection):
380 mg delivered intramuscularly in the
gluteal region every 4 weeks; alternate
buttocks; must be administered by healthcare
professional
Patient should be opioid free for 710 days
prior to initiating treatment, as confirmed
by negative urine screen and/or naloxone
challenge test
Opioid dependence (oral): initial 25 mg/
day; day 2 can increase to 50 mg/day
Dosing Tips
Providing educational materials and
counseling in combination with naltrexone
treatment can increase the chances of
success
Individuals who abstain from alcohol for
several days prior to initiating treatment
with naltrexone may have greater
reductions in the number of drinking days
as well as number of heavy drinking days,
and may also be more likely to abstain
completely throughout treatment
Long-acting naltrexone (injection) must be
kept refrigerated
For long-acting naltrexone (injection),
the suspension should be administered
immediately after mixing
Adherence greatly enhanced and assured
for 30 days at a time when administering by
once monthly depot injection; oral treatment
requires 30 decisions to comply in 30 days
whereas long-acting injection requires only
one decision every 30 days to comply
Patients must be completely withdrawn
and abstinent from opioids for 5 days
opioids than previously used, and thus
previous doses may also lead to opioid
intoxication
Individuals receiving naltrexone who
require pain management with opioid
analgesia may need a higher dose than
usual and may experience deeper and
more prolonged respiratory depression;
pain management with non-opioid or rapid
acting opioid analgesics is recommended
if possible
Monitor patients for emergence of
depressed mood or suicidality
Use cautiously in individuals with known
psychiatric illness
Injection should be used cautiously in
individuals with thrombocytopenia or any
coagulation disorder

Do Not Use

If patient is taking opioid analgesics
If patient is currently dependent on opioids
or is in acute opiate withdrawal
If patient has failed the naloxone challenge
test or has a positive urine screen for opioids
If patient has acute hepatitis or liver failure
If there is a proven allergy to naltrexone
If there is a proven allergy to polylactidecoglycolide
(PLG), arboxymethylcellulose,
or any other components of the diluent (injection

Elderly

Safety and efficacy have not been
established
Some patients may tolerate lower doses
better

Children and Adolescents

Safety and efficacy have not been
established
Pregnancy
Risk Category C [some animal studies
show adverse effects; no controlled studies
in humans]
Pregnant women needing to stop drinking
may consider behavioral therapy before
pharmacotherapy
Not generally recommended for use during
pregnancy, especially during fi rst trimester
Breast Feeding
Some drug is found in mothers breast milk
Recommended either to discontinue drug
or bottle feed

SPECIAL POPULATIONS

Renal Impairment
Dose adjustment not generally necessary
for mild impairment
Not studied in moderate to severe renal
impairment
Hepatic Impairment
Has the potential to cause hepatocellular
injury when given in excessive doses
Dose adjustment not generally necessary
for mild impairment
Not studied in severe hepatic impairment
Contraindicated in acute hepatitis or liver
failure
Cardiac Impairment
Limited available data

THE ART OF PSYCHOPHARMACOLOGY

Potential Advantages
Individuals who are not ready to abstain
completely from alcohol
For binge drinkers
Potential Disadvantages
Patients who drink over their treatment,
including their long-acting injection
Less effective in patients who are not
abstinent at the time of treatment initation
Primary Target Symptoms
Alcohol dependence

Pearls

Not only increases total abstinence, but
also can reduce days of heavy drinking
May be a preferred treatment if the goal is
reduced-risk drinking (i.e., 34 drinks per
day in men, maximum 16 drinks per week;
23 drinks per day in women, maximum
12 drinks per week)
Less effective in patients who are not
abstinent at the time of treatment
initiation
Some patients complain of apathy or loss
of pleasure with chronic treatment
The combination of naltrexone and
bupropion has demonstrated effi cacy as
treatment for obesity and is currently being
evaluated in a long-term study to assess
the cardiovascular health outcomes of this
treatment.

Suggested Reading

Anton RF , OMalley SS , Ciraulo DA , et al.
Combined pharmacotherapies and behavioral
interventions for alcohol dependence: the
COMBINE study: a randomized controlled trial .
JAMA 2006 ; 295 (17): 2003 17.
Johansson BA , Berglund M , Lindregn A .
Effi cacy of maintenance treatment with
naltrexone for opioid dependence:
a meta-analytical review . Addiction
2006 ; 101 (4): 491 503.
Mannelli P , Peindl K , Masand PS , Patkar SS .
Long-acting injectable naltrexone for the
treatment of alcohol dependence . Expert Rev
Neurother 2007 ; 7 (10): 1265 77.
Rosner S , Leucht S , Lehert P , Soyka M .
Acamprosate supports abstinence, naltrexone
prevents excessive drinking: evidence from
a meta-analysis with unreported outcomes .
J Psychopharmacol 2008 ; 22 : 11 23.

Several therapeutic agents exploit the known pharmacology of alcohol and are approved for treating alcohol dependence. One of these, naltrexone, blocks -opioid receptors ( Figure 14-16 ). As for opioid abuse, -opioid receptors theoretically also contribute to the euphoria and high of heavy drinking. It is therefore not surprising that a -opioid antagonist would block the enjoyment of heavy drinking and increase abstinence by its actions upon reward circuitry ( Figure 14-16 ). This theory is supported by clinical trials, which show that naltrexone not only increases the chances of attaining complete abstinence from alcohol, but also reduces heavy drinking (defined as five or more drinks per day for a man and four or more for a woman). Outcomes for patients with alcohol dependence who take naltrexone may be more favorable when the form of naltrexone that is administrated is given once monthly by intramuscular injection, called XR-naltrexone. This may be due to the fact that this method of drug administration forces compliance for at least a month. Monthly rather than daily drug administration may be just what the reward circuitry needs for someone with a substance-abuse problem. As discussed earlier in this chapter, patients addicted to various substances lose their ability to make rational decisions, and instead respond immediately and impulsively to the desire to seek drugs, and have vast capacity for denial of the maladaptive nature of their compulsive decisions. It is hard enough to get a patient with a substance-abuse disorder to enter treatment or take medications at all, let alone make that person decide every day not only to stay abstinent but also to take a medication. Addiction and human nature being what they are , it is not surprising that patients frequently drop out of treatment and resume substance abuse. If you drink when you take naltrexone, the opioids released do not lead to pleasure, so why bother drinking? Some patients may also of course say, why bother taking naltrexone? and relapse back into drinking alcohol. However, if you have been given an injection that lasts for a month, and have an irresistible impulse to drink, and you slip and start to drink, you are not able to discontinue your naltrexone. Thus, if you drink over your naltrexone, you may discover that you do not get the buzz or enjoyment out of intoxication, and therefore might stop after a few drinks. You might even become abstinent for several days again.

Stahl, Stephen M. (2013-04-11). Stahl's Essential Psychopharmacology (Kindle Locations 12085-12103). Cambridge University Press. Kindle Edition.

There have been members of this board who pop by now and then that have great success with natrextrone alone or combined with other therapies. They aren't as numerous as they tend to feel self- empowered about their decision to stop being victims of alcohol, and don't come here as regularly as the need for a daily reprieve based on the maintenance of their spiritual condition isn't the cornerstone of their sobriety...

Naltrexone is better known and accepted in some other addiction support groups like SMART than in AA...

I've got zero interest in a chemical "cure" for alcoholism personally. I'm recovered, and I have a life that is better than I thought possible. The most important piece is I don't pick up that first drink, but the benefits of sobriety extend far far beyond that and I can't get those benefits through an opiate blocker.

That said, if someone is physically addicted, I'm all for whatever can get them clean and sober so they can start the work and reap the benefits of living a rich sober life.