From the Guidelines
For the treatment of alcoholism, naltrexone is typically prescribed at a dose of 50 mg once daily, as recommended by the most recent and highest quality study 1. This dosing schedule is based on the medication's mechanism of action, which involves blocking opioid receptors in the brain to reduce the pleasurable effects of alcohol and decrease cravings. Treatment usually begins after the patient has been abstinent from alcohol for at least 3-5 days to avoid precipitating withdrawal symptoms. Some patients may start at a lower dose of 25 mg daily for the first few days to minimize side effects like nausea, headache, and dizziness before increasing to the standard 50 mg dose. The medication should be taken consistently at the same time each day, with or without food, though taking it with food may help reduce gastrointestinal side effects. Key considerations for naltrexone treatment include:
- Performing liver function tests before starting the medication due to the risk of hepatotoxicity
- Contraindication in patients with acute hepatitis or liver failure
- Informing patients that naltrexone will block the effects of opioid pain medications, and advising them to carry medical identification indicating they are taking naltrexone in case of emergency pain management
- Treatment duration typically ranges from 3-12 months, though some patients may benefit from longer treatment, as supported by studies such as 1 and 1. It's also worth noting that alternative dosing schedules, such as 100 mg on Mondays and Wednesdays, and 150 mg on Fridays, or a 380-mg monthly injection, may be considered, as mentioned in 1. However, the 50 mg daily dose is the most commonly recommended and studied regimen.
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 dosing schedule of naltrexone for the treatment of alcoholism is 50 mg once daily 2. This dose regimen has been shown to be effective in reducing alcohol consumption and improving treatment outcomes in clinical trials. It is essential to note that naltrexone should be used as part of a comprehensive treatment plan that includes social and psychotherapeutic methods to enhance patient compliance.
- The treatment duration may vary, but the studies that demonstrated the efficacy of naltrexone used a dose regimen for up to 12 weeks.
- Alternative dosing schedules may be employed in cases of supervised administration, but the degree of blockade produced by naltrexone may be reduced by extended dosing intervals 2.
From the Research
Dosing Schedule of Naltrexone for Alcoholism
The recommended dosing schedule of naltrexone for the treatment of alcoholism is as follows:
- The usual dosage is 50 mg per day 3
- High-dose naltrexone (150 mg/day) has also been studied and found to be safe and well tolerated, significantly reducing alcohol consumption 4
- Naltrexone 50 mg/day has been shown to reduce alcohol consumption and relapse rates in alcohol dependents 5, 6
Key Findings
- Naltrexone (50 mg/day) plus psychotherapy has been found to be effective in alcohol-dependent patients, with high clinical efficacy and a safety profile comparable to that of a placebo 6
- A meta-analysis of randomized controlled trials found that naltrexone was 27% better than placebo in supporting continuous abstinence 7
- Naltrexone should be used as an adjunct to a comprehensive alcohol treatment program that addresses concomitant medical problems and psychosocial concerns 3