From the Guidelines
Naltrexone for alcohol use disorder is typically prescribed at 50 mg once daily by mouth, as recommended by the most recent and highest quality study 1.
Naltrexone Dosing for ETOH
The dosing of naltrexone for alcohol use disorder (ETOH) is a crucial aspect of treatment.
- The standard dose is 50 mg once daily by mouth, which can be taken consistently with or without food.
- Treatment can begin immediately if the patient is not actively drinking, but should be initiated only after the patient has been abstinent for at least 3-5 days if they have been drinking heavily to avoid precipitating withdrawal.
- Some providers start with 25 mg daily for 3-7 days to minimize side effects before increasing to the standard 50 mg dose.
Mechanism of Action and Efficacy
Naltrexone works by blocking opioid receptors in the brain, reducing the pleasurable effects of alcohol and decreasing cravings.
- This helps patients maintain abstinence or reduce heavy drinking days.
- Common side effects include nausea, headache, dizziness, and fatigue, which typically improve with continued use.
Safety Considerations
Liver function should be monitored as naltrexone can cause hepatotoxicity at higher doses, and it's contraindicated in acute hepatitis or liver failure.
- Patients should be warned that naltrexone will block the effects of opioid pain medications if needed for emergencies, as noted in 1 and 1.
Duration of Treatment
The medication should be continued for at least 3-6 months, though many patients benefit from longer treatment durations of 12 months or more.
- The most recent study 1 provides guidance on the use of naltrexone in patients with alcohol use disorder, and its findings support the use of this medication as a first-line treatment option.
From the FDA Drug Label
Treatment of Alcoholism A dose of 50 mg once daily is recommended for most patients The placebo-controlled studies that demonstrated the efficacy of naltrexone hydrochloride as an adjunctive treatment of alcoholism used a dose regimen of naltrexone hydrochloride 50 mg once daily for up to 12 weeks.
The recommended dose of naltrexone for the treatment of alcoholism (ETOH) is 50 mg once daily 2.
From the Research
Naltrexone Dosing for Alcohol Dependence
- The standard dose of naltrexone for treating alcohol dependence is 50 mg/day, as shown in studies 3, 4.
- This dose has been found to reduce relapse rates and cravings, and increase abstinence rates in alcohol-dependent patients.
- High-dose naltrexone (150 mg/day) has also been studied and found to be safe and well-tolerated, with significant reductions in alcohol consumption 5.
- Common adverse effects of naltrexone at a dose of 50 mg/day include nausea and vomiting, but it does not appear to be hepatotoxic at this dose 3.
Comparison of Naltrexone with Other Medications
- Naltrexone is one of three medications approved by the U.S. Food and Drug Administration for treating alcohol dependence, along with disulfiram and acamprosate 6, 7.
- Naltrexone has been found to be more effective than disulfiram in reducing relapse rates and cravings, and increasing abstinence rates 7.
- Acamprosate has also been found to reduce relapse rates and increase abstinence rates, but its mechanism of action is different from that of naltrexone 7.