From the Guidelines
Naltrexone is primarily indicated for the treatment of alcohol use disorder and opioid use disorder. For alcohol dependence, it helps reduce cravings and the pleasurable effects of alcohol, typically prescribed at 50 mg once daily orally, or as a monthly 380 mg extended-release injection (Vivitrol) 1. For opioid dependence, naltrexone blocks opioid receptors, preventing the euphoric effects of opioids, with the same dosing options. Patients must be fully detoxified from opioids (7-10 days opioid-free) before starting naltrexone to avoid precipitating withdrawal.
Key Considerations
- Naltrexone works by antagonizing mu-opioid receptors, blocking both endogenous and exogenous opioids, which reduces the reward associated with substance use and helps maintain abstinence 1.
- Common side effects include nausea, headache, dizziness, anxiety, and fatigue.
- Liver function should be monitored as naltrexone can cause hepatotoxicity at higher doses 1.
- Naltrexone is also used off-label at lower doses (4.5 mg) for pain conditions and autoimmune disorders.
Special Populations
- Naltrexone may be a good therapeutic option for adolescents and young adults with co-occurring alcohol use disorder, as well as those living in unstable or unsupervised housing 1.
- However, it is essential to note that naltrexone cannot be used in patients in whom opioids are required for pain control, because it will block pain relief from opioid agonists and cause withdrawal symptoms 1.
From the FDA Drug Label
Naltrexone hydrochloride tablets USP 50 mg is indicated in the treatment of alcohol dependence and for the blockade of the effects of exogenously administered opioids. A dose of 50 mg once daily is recommended for most patients Treatment of Opioid Dependence Treatment should be initiated with an initial dose of 25 mg of naltrexone hydrochloride. If no withdrawal signs occur, the patient may be started on 50 mg a day thereafter
The main indications for Naltrexone are:
- Alcohol dependence
- Blockade of the effects of exogenously administered opioids
- Opioid dependence The recommended dose is 50 mg once daily for alcohol dependence and 25 mg initially, then 50 mg daily for opioid dependence 2 2
From the Research
Naltrexone Indication
- Naltrexone is an opioid antagonist that can be used to treat opioid use disorder, as shown in a study published in 2019 3.
- It is also effective in treating alcohol dependence, as stated in a review of the evidence published in 2002 4.
- Naltrexone works by blocking the effects of opioid agonists, and it can be administered orally or through a long-acting injection 5.
- The medication is approved by the Food and Drug Administration for the management of opioid use disorder, along with methadone and buprenorphine 6.
- Long-acting intramuscular naltrexone is an effective treatment for opioid use disorder, but its use is relatively rare, with only 0.26% of veterans with OUD filling a prescription for it nationally 7.
Treatment of Opioid Use Disorder
- Naltrexone can be used to manage withdrawal, reduce cravings, and block the effects of nonmedical opioid use 6.
- The choice of medication for opioid use disorder depends on various factors, and outcomes are improved with multicomponent and interprofessional strategies 6.
- Screening for opioid use disorder is indicated for certain populations, including pregnant women, but universal screening is not currently recommended 6.
- Naltrexone is primarily used for patients with multiple co-morbidities, especially alcohol use disorder and serious mental illness 7.
Administration and Efficacy
- Long-acting injection naltrexone has been shown to be superior to oral naltrexone in reducing opioid use over 6 months of treatment 3.
- Patients receiving long-acting injection naltrexone had twice the rate of treatment retention at 6 months compared to those taking oral naltrexone 3.
- Naltrexone can be an effective treatment for alcohol and opioid dependence if issues of compliance are adequately addressed 4.