From the Guidelines
Naltrexone is not strongly associated with improved abstinence in patients with alcohol addiction, with a odds ratio of 1.36 (0.97 to 1.91) compared to placebo, as shown in a recent systematic review and network meta-analysis 1.
Key Points to Consider
- The evidence for naltrexone's effectiveness in maintaining abstinence is low to very low due to within-study bias, imprecision, and heterogeneity 1.
- However, when combined with other medications such as acamprosate and sodium oxybate, naltrexone may be more effective in maintaining abstinence 1.
- Naltrexone works by blocking opioid receptors in the brain, reducing the pleasurable effects of alcohol and decreasing cravings.
- The standard oral dose is 50mg once daily, though some patients may start at 25mg to minimize side effects.
- Treatment typically continues for at least 6-12 months, though some patients benefit from longer use.
Important Considerations
- Naltrexone should be used as part of a comprehensive treatment program that includes counseling or therapy.
- Before starting, patients should be alcohol-free for at least 3-7 days and have normal liver function tests, as naltrexone can cause liver damage at high doses 1.
- Common side effects include nausea, headache, dizziness, and fatigue, which usually improve over time.
- Naltrexone is contraindicated in patients taking opioid medications or with acute hepatitis or liver failure 1.
Combination Therapy
- Combining naltrexone with other medications such as acamprosate and sodium oxybate may improve its effectiveness in maintaining abstinence 1.
- Brief motivational interventions should be routinely used in the medical management of alcohol use disorders 1.
- Success rates improve significantly when combined with behavioral interventions and regular medical follow-up.
From the FDA Drug Label
The efficacy of naltrexone hydrochloride as an aid to the treatment of alcoholism was tested in placebo-controlled, outpatient, double blind trials. In one of these studies, 104 alcohol-dependent patients were randomized to receive either naltrexone hydrochloride tablets 50 mg once daily or placebo. In this study, naltrexone hydrochloride proved superior to placebo in measures of drinking including abstention rates (51% vs 23%), number of drinking days, and relapse (31% vs. 60%). In a second study with 82 alcohol-dependent patients, the group of patients receiving naltrexone hydrochloride were shown to have lower relapse rates (21% vs. 41%), less alcohol craving, and fewer drinking days compared with patients who received placebo, but these results depended on the specific analysis used Results of this study demonstrated that the side effect profile of naltrexone hydrochloride appears to be similar in both alcoholic and opioid dependent populations, and that serious side effects are uncommon. In the clinical studies, treatment with naltrexone hydrochloride supported abstinence, prevented relapse and decreased alcohol consumption
Naltrexone for Alcohol Addiction: Naltrexone hydrochloride has been shown to be effective in the treatment of alcoholism, with studies demonstrating its ability to support abstinence, prevent relapse, and decrease alcohol consumption.
- The recommended dose is 50 mg once daily for 12 weeks as an adjunct to social and psychotherapeutic methods.
- Key Benefits:
- Supported abstinence
- Prevented relapse
- Decreased alcohol consumption
- Lower relapse rates
- Less alcohol craving
- Fewer drinking days 2
From the Research
Efficacy of Naltrexone in Alcohol Addiction Treatment
- Naltrexone has been shown to be effective in reducing relapse to heavy drinking in individuals with alcohol dependence 3, 4, 5, 6, 7.
- The medication works by blocking the effects of opioids in the brain, which can help reduce cravings for alcohol and prevent relapse 6.
- Studies have found that naltrexone is most effective when combined with cognitive behavioral therapy (CBT) or other forms of behavioral therapy 3, 5.
Combination Therapy with Naltrexone
- Combining naltrexone with CBT has been shown to be more effective than combining it with motivational enhancement therapy or supportive therapy 3, 5.
- The combination of naltrexone and CBT has been found to reduce the risk of relapse and improve treatment outcomes in individuals with alcohol dependence 3, 5.
Outcome Measures for Naltrexone Treatment
- Studies have found that naltrexone is more effective in reducing heavy drinking than in promoting abstinence 7.
- Outcome measures related to heavy or excessive drinking are most relevant to defining naltrexone's therapeutic effects 7.