From the Guidelines
Naloxone is not typically used to treat alcohol use disorder (AUD) directly, and instead, medications like naltrexone are used to manage AUD by blocking opioid receptors in the brain, reducing the pleasurable effects of alcohol and decreasing cravings. The role of naloxone in managing alcohol use disorder is limited, as it is primarily used for reversing acute opioid overdose 1. Naltrexone, on the other hand, is FDA-approved for AUD treatment and is available in oral and injectable formulations. The standard oral naltrexone regimen for AUD is 50 mg once daily, or as a monthly injectable formulation (Vivitrol) at 380 mg.
Some key points to consider when using naltrexone for AUD treatment include:
- Starting naltrexone only after the patient is abstinent from alcohol for at least 3-5 days to avoid precipitating withdrawal
- Checking liver function tests before starting treatment, as naltrexone can cause hepatotoxicity
- Common side effects include nausea, headache, dizziness, and fatigue
- Warning patients that naltrexone will block the effects of opioid pain medications, so they should carry medical identification
- Combining naltrexone with counseling or behavioral therapy as part of a comprehensive treatment approach for alcohol use disorder, as this has been shown to be effective in reducing relapse rates and improving outcomes 1.
It's also important to note that abstinence is the most important therapeutic intervention for patients with alcoholic liver disease, and medications like naltrexone can help sustain abstinence and reduce the risk of relapse 1. However, naloxone is not typically used for this purpose, and its role is primarily limited to reversing acute opioid overdose.
From the Research
Role of Naloxone in Managing Alcohol Use Disorder
- There is no direct evidence to suggest that naloxone plays a role in managing alcohol use disorder.
- Naloxone is primarily used for the treatment of life-threatening heroin/opioid overdose in emergency medicine 2.
- The primary medications used to treat alcohol use disorder include naltrexone, acamprosate, and disulfiram 3, 4, 5, 6.
- Naltrexone is an opioid receptor antagonist that has been shown to be effective in reducing alcohol consumption and blocking the rewarding aspects of drinking 3, 4, 5, 6.
- Acamprosate and disulfiram are also used to treat alcohol use disorder, although their mechanisms of action and efficacy vary 3, 4, 5, 6.
- Other medications, such as baclofen, gabapentin, and topiramate, have been investigated for their potential use in treating alcohol use disorder, but more research is needed to fully understand their efficacy and safety 5.