What conditions are treated with naltrexone (Naltrexone)?

From the Guidelines

Naltrexone is primarily used to treat alcohol use disorder and opioid use disorder by blocking opioid receptors in the brain, reducing cravings and the pleasurable effects of these substances.

Key Points

• Naltrexone works by blocking the effects of opioids, which can help prevent relapse in motivated individuals, particularly those with a history of opioid or alcohol dependence 1.
• The standard dose for alcohol dependence is typically 50 mg once daily, while for opioid dependence, it's also 50 mg daily, or a monthly injectable form called Vivitrol (380 mg) 1.
• Patients should be opioid-free for 7-10 days before starting naltrexone to avoid precipitating withdrawal, and it's essential to monitor liver function tests due to the risk of hepatic injury at high doses 1.
• Naltrexone is not addictive and doesn't cause withdrawal when stopped, making it a valuable option for treating opioid and alcohol use disorders 1.
• The medication is most effective when combined with counseling or behavioral therapy as part of a comprehensive treatment program, and it has also been used off-label for conditions like fibromyalgia and multiple sclerosis, though evidence for these uses is less robust 1.

Treatment Considerations

• Clinicians should assess for opioid use disorder using DSM-5 criteria and offer evidence-based treatment, which may include medication-assisted treatment with buprenorphine, methadone, or naltrexone, in combination with behavioral therapies 1.
• Naltrexone can be used in non-pregnant adults, and it's crucial to consider the patient's motivation and the availability of counseling or behavioral therapy when deciding on treatment 1.
• Resources are available to help clinicians arrange for treatment, including SAMHSA's buprenorphine physician locator and the Opioid Treatment Program Directory 1.

From the FDA Drug Label

Naltrexone hydrochloride has been shown to produce complete blockade of the euphoric effects of opioids in both volunteer and addict populations. The efficacy of naltrexone hydrochloride as an aid to the treatment of alcoholism was tested in placebo-controlled, outpatient, double blind trials.

Naltrexone treats:

• Opioid addiction: by producing complete blockade of the euphoric effects of opioids
• Alcoholism: as an aid to treatment, by reducing alcohol consumption and preventing relapse 2 Note: The use of naltrexone for other conditions is not supported by the provided drug labels.

From the Research

Naltrexone Treatment

Naltrexone is used to treat various conditions, including:

• Opioid dependence: Naltrexone blocks the reinforcing effects of opioids and reduces craving 3, 4, 5, 6
• Alcohol dependence: Naltrexone reduces alcohol consumption and craving, although its effectiveness is less evident than for opioid dependence 3, 4, 7
• Other potential uses: Naltrexone has been investigated for use in treating other substance use disorders, such as cocaine and nicotine dependence, as well as psychiatric disorders, but its efficacy for these conditions is not yet established 7

Forms of Naltrexone

Naltrexone is available in various forms, including:

• Oral tablets: The traditional form of naltrexone, which has limitations due to poor compliance 3, 5
• Injectable depot formulations: Long-acting injectable formulations that provide naltrexone release for at least 1 month 3, 4
• Implant formulations: Long-acting implant formulations that release naltrexone for up to 7 months 3, 5