From the Guidelines
Twitching in sleep on naltrexone is generally not considered dangerous, but it's essential to discuss this with your healthcare provider to rule out any underlying conditions that may be contributing to the symptom. When considering the management of twitching in sleep while taking naltrexone, it's crucial to prioritize the patient's morbidity, mortality, and quality of life. The evidence suggests that naltrexone, particularly at low doses (3-5 mg), can be effective in managing chronic neuropathic pain and improving quality of life 1. However, common side effects of low-dose naltrexone (LDN) include headache, tachycardia, and vivid dreams, which may be related to the twitching experienced during sleep.
Some key points to consider when managing twitching in sleep on naltrexone include:
- The dose and timing of naltrexone administration: taking naltrexone earlier in the day rather than before bedtime might help reduce sleep disturbances, including twitching.
- Maintaining good sleep hygiene practices, such as keeping a regular sleep schedule and avoiding caffeine in the evening, can also help alleviate symptoms.
- Monitoring for any underlying conditions that may be contributing to the twitching, such as neuropathic pain or other sleep disorders, is essential to provide comprehensive care.
It's also important to note that naltrexone has been associated with hepatic injury at supratherapeutic doses, and liver function tests should be performed at baseline and every three to six months 1. However, this is more relevant to higher doses of naltrexone used for opioid dependence rather than the low doses used for neuropathic pain management.
In terms of specific management strategies, the most effective approach would be to discuss the symptoms with a healthcare provider and consider adjusting the dose or timing of naltrexone administration, while also implementing good sleep hygiene practices and monitoring for any underlying conditions. This approach prioritizes the patient's morbidity, mortality, and quality of life, while also taking into account the potential benefits and risks of naltrexone therapy.
From the FDA Drug Label
Musculoskeletal: Painful shoulders, legs or knees; tremors, twitching. The FDA drug label mentions twitching as a possible adverse event associated with naltrexone hydrochloride, but it does not specifically address twitching in sleep.
- The label reports twitching as an event that occurred in less than 1% of subjects.
- However, it does not provide information on whether this twitching occurred during sleep or wakefulness 2.
From the Research
Naltrexone and Sleep Twitching
- There is limited research directly addressing the relationship between naltrexone and sleep twitching.
- However, studies have investigated the side effects of naltrexone, which may include neurological complaints such as twitching or muscle spasms 3.
- A study on low-dose naltrexone for gastrointestinal disorders found that 58 out of 121 patients experienced neurological side effects, including twitching or muscle spasms 3.
- Another study on the use of low-dose naltrexone for Stiff-Person Syndrome, a rare neurologic disorder characterized by muscle stiffness and rigidity, found that the treatment reduced symptoms of muscle tightness and spasms in a patient 4.
- While these studies do not specifically address sleep twitching, they suggest that naltrexone may be associated with neurological side effects, including muscle spasms or twitching, which could potentially occur during sleep 3, 4.
Naltrexone Side Effects
- Common side effects of naltrexone include nausea, headache, and dizziness 5, 3.
- Neurological side effects, such as anxiety, depression, and insomnia, have also been reported 3, 6.
- The frequency and severity of side effects may vary depending on the dose and individual response to the medication 3, 6.