What is the recommended treatment protocol for alcohol use disorder using naltrexone (opioid receptor antagonist)?

From the Guidelines

Naltrexone is recommended as a treatment for alcohol use disorder, with a typical daily oral dose of 50mg, and should be combined with psychosocial interventions for optimal outcomes. The medication works by blocking opioid receptors in the brain, reducing the pleasurable effects of alcohol and decreasing cravings, which helps patients maintain abstinence or reduce heavy drinking days 1. Treatment should continue for at least 3-6 months, with some patients benefiting from longer durations of up to 12 months. Naltrexone can be initiated while the patient is still drinking, though it's preferable to begin after detoxification.

Some key points to consider when using naltrexone for alcohol use disorder include:

• Common side effects include nausea, headache, and dizziness, which typically subside within the first week
• Liver function should be monitored as naltrexone is contraindicated in acute hepatitis or liver failure
• Patients should be warned that naltrexone will block the effects of opioid pain medications, and they should carry medical identification indicating they are taking naltrexone in case emergency pain management is needed
• Naltrexone has been shown to be effective in reducing the likelihood of relapse in patients with alcohol abuse/dependence, and can be considered in combination with counseling to achieve this goal 1
• The medication has been studied in various patient populations, including those with alcoholic liver disease, and has been found to be safe and effective in these patients, although it is not recommended for use in patients with acute hepatitis or liver failure 1.

Overall, naltrexone is a valuable treatment option for alcohol use disorder, and should be considered as part of a comprehensive treatment plan that includes psychosocial interventions and ongoing monitoring and support.

From the FDA Drug Label

To reduce the risk of precipitated withdrawal in patients dependent on opioids, or exacerbation of a preexisting subclinical withdrawal syndrome, opioid-dependent patients, including those being treated for alcohol dependence, should be opioid-free (including tramadol) before starting naltrexone hydrochloride treatment 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 treatment protocol for alcohol use disorder using naltrexone is to administer 50 mg once daily, as an adjunct to social and psychotherapeutic methods, for up to 12 weeks. Patients should be opioid-free for at least 7 to 10 days before starting naltrexone hydrochloride treatment to reduce the risk of precipitated withdrawal. Compliance-enhancing techniques should be implemented to ensure medication adherence. 2

From the Research

Naltrexone Treatment Protocol for Alcohol Use Disorder

• Naltrexone is an opioid receptor antagonist that has been shown to be effective in reducing heavy drinking and craving in individuals with alcohol use disorder 3, 4, 5.
• The recommended dosage of naltrexone for alcohol use disorder is 50 mg/day 5, 6.
• Requiring abstinence before treatment with naltrexone has been associated with larger effect sizes for abstinence maintenance and reduced heavy drinking compared with placebo 3.
• Naltrexone has been found to be slightly more efficacious in reducing heavy drinking and craving, while acamprosate is slightly more efficacious in promoting abstinence 3, 4.
• Combination treatment with naltrexone and cognitive behavioral therapy (CBT) has been shown to be effective in increasing the time to first relapse and reducing the number of relapses 6.

Comparison with Other Treatments

• Acamprosate has been found to be more effective in promoting abstinence, while naltrexone is more effective in reducing heavy drinking and craving 3, 4, 5.
• Disulfiram is another medication approved for the treatment of alcohol use disorder, but its use is not as well-studied as naltrexone and acamprosate 7.
• Anticonvulsants, such as baclofen, have been used off-label for the treatment of alcohol use disorder, but their efficacy is not as well-established as naltrexone and acamprosate 7.

Clinical Considerations

• Naltrexone should be used in combination with behavioral therapies, such as CBT, to maximize its effectiveness 6.
• Patients should be closely monitored for adverse events and medication adherence when taking naltrexone 4, 5.
• The safety of naltrexone in combination with other medications, such as acamprosate, has been supported by clinical trials 4.