From the Guidelines
For a driver taking naltrexone with medical clearance, the Department of Transportation (DOT) typically issues a 1-year medical card rather than the standard 2-year certification. This is because naltrexone, which is commonly used to treat alcohol or opioid dependence, requires ongoing monitoring to ensure the driver remains medically fit for duty. The medical examiner will want to evaluate the driver's condition annually to confirm that the medication is being taken as prescribed, that the underlying condition is stable, and that there are no adverse effects that could impair driving ability.
Key Considerations
- The driver must provide documentation from their treating physician stating that they are compliant with treatment, experiencing no side effects that would interfere with safe driving, and that the condition for which naltrexone is prescribed is under control 1.
- This annual certification requirement allows for appropriate safety monitoring while still permitting qualified drivers to maintain their commercial driving privileges.
- The driver should maintain regular follow-up appointments with their prescribing physician between DOT examinations.
Evidence Review
While studies such as 1 and 1 discuss the evaluation of psychotropic drugs on driving performance, they do not directly address the certification period for drivers taking naltrexone. However, the principle of regular monitoring for safety applies, as emphasized in 1, which discusses the use of naltrexone in treating opioid dependence and the importance of monitoring for side effects and treatment compliance.
Clinical Implications
In clinical practice, the focus is on ensuring that the driver's condition does not pose a risk to themselves or others on the road. Given the potential for naltrexone to impact driving ability, particularly if not taken as prescribed or if the underlying condition is not well-managed, annual evaluation is a prudent approach to balance safety with the need for individuals to maintain their livelihoods.
From the Research
DOT Medical Card and Naltrexone
- The provided studies do not directly address the issue of DOT medical card duration for a driver taking naltrexone with medical clearance.
- However, the studies suggest that naltrexone is generally safe and well-tolerated, with no significant evidence of hepatotoxicity or other serious side effects 2, 3, 4, 5, 6.
- The studies focus on the safety and efficacy of naltrexone in treating alcoholism and other conditions, rather than its impact on DOT medical card eligibility or duration.
- There is no specific information available on the duration of a DOT medical card for a driver taking naltrexone with medical clearance, as this is a regulatory issue rather than a medical one.
Naltrexone Safety
- The studies consistently show that naltrexone is safe and well-tolerated, with no significant evidence of hepatotoxicity or other serious side effects 2, 3, 4, 5, 6.
- One study found that naltrexone was discontinued in 15.0% of patients due to adverse events, most frequently nausea 2.
- Another study found that gamma-glutamyltransferase levels were lower in patients receiving extended-release naltrexone compared to placebo 4.
- The studies suggest that naltrexone can be safely used in patients with liver disease, and that regular liver function tests may not be necessary 3, 6.