How Naltrexone Is Used to Treat Alcohol Use Disorder
Alcohol use disorder (AUD) is a chronic, relapsing medical condition characterized by compulsive alcohol use, loss of control over consumption, and physical dependence. Despite negative social, occupational, and health consequences, individuals with AUD are unable to stop drinking because of changes in their brain chemistry that lead to intense alcohol cravings and withdrawal symptoms.
Previously referred to as alcoholism or alcohol dependence, AUD is a serious global public health issue. It causes about 3 million deaths worldwide every year, accounting for up to 6% of all deaths globally. In the United States, around 14 million adults are diagnosed with AUD, with men being disproportionately affected. Approximately twice as many men as women have the disorder, and men are three times more likely to die from alcohol-related causes. Just over 6% of people who have consumed alcohol at some point in their lives will develop AUD.
Naltrexone is a medication that reduces cravings and blocks the rewarding effects associated with drinking alcohol. It supports alcohol treatment programs by decreasing a person’s urges and impulses to drink and lowers the risk of relapse.
Table of Contents
How Naltrexone Helps with Alcoholism
Mu-opioid receptors in the brain mediate pleasure and reinforce the desire to drink alcohol. When naltrexone blocks these receptors, it blocks the euphoric, sedative, and rewarding effects of alcohol. This reduces cravings and motivation to drink alcohol.
Naltrexone is not an opioid, and it is not addictive. It does not cause withdrawal symptoms when treatment is stopped. Naltrexone has been used for decades to help people with AUD reduce their risk of relapse.
Naltrexone is less effective than other AUD treatment options for abstinence but is more effective for decreasing the time and frequency of binge drinking and the overall average number of drinks consumed.
A review of multiple studies found that naltrexone significantly decreases relapse rates and the number of drinks consumed. It substantially increases the number of days of abstinence.1
Treating Alcoholism
AUD is a serious medical condition that affects about 6% of U.S. adults. Yet fewer than 10% of Americans with AUD are being treated for their condition. Only about 1.6% have ever used a medication to treat AUD.2
Three medications are FDA-approved to treat AUD: disulfiram, naltrexone, and acamprosate. According to the American Psychiatric Association Practice Guideline, naltrexone should be offered to anyone with a moderate-to-severe AUD to help them reduce alcohol consumption and achieve abstinence.
Naltrexone treatment length and dose vary and depend on your medical needs and your doctor’s assessment of your progress. There is no predefined treatment length. If naltrexone is helping and any potential side effects are manageable, your doctor may recommend continuing naltrexone for months to years to prevent relapse.
Types of Naltrexone Administration
Naltrexone is prescribed in two ways. High-dose naltrexone is used to treat AUD or opioid use disorder. A much lower dose of naltrexone is used for pain management, to reduce inflammation, and to aid in weight loss.
Naltrexone is also available in many forms and can be combined with other medications.
Oral Tablet
Oral naltrexone is typically prescribed as a 50 mg daily dose. Your doctor may start at a lower dose to decrease side effects such as nausea. Taking naltrexone with meals can reduce nausea and stomach upset.
The typical treatment duration is 12 weeks.3
Alternative dosing regimens include:3
- 50 mg on weekdays, 100 mg on Saturdays
- 100 mg every other day
- 150 mg every three days
It is important to take naltrexone as prescribed to reduce your risk of health complications and serious side effects.
Injection
Naltrexone is also available as a long-acting injectable. The medication is injected into the gluteal muscle once every four weeks. The typical treatment duration is 24 weeks.3
Implant
Naltrexone implants are being studied for their potential use in treating AUD, but at this time, they are not a recommended first-line therapy.
Naltrexone in Conjunction with Other Treatments
To achieve the best results, naltrexone should be part of a comprehensive alcohol treatment plan. Naltrexone is most effective when combined with comprehensive counseling, peer support, behavioral therapy, and/or a 12-step program. Counseling and support groups can help people with AUD manage situations and feelings that provoke a need to resume or increase alcohol use.
Lifestyle treatment plans can support weight loss, exercise, and anti-aging goals. Consuming a nutritious diet, engaging in regular exercise, prioritizing restful sleep, and learning strategies to manage stress can support your efforts to treat AUD. If you are interested in learning more about these options, consult with a medical professional at Invigor Medical.
What To Know Before Starting Naltrexone
If you have AUD or your use of alcohol is concerning to you, consult with a medical professional. Screening questionnaires are available to help you assess the severity of your alcohol use. Your doctor will discuss the results of your questionnaire and your medical history. It is important to identify whether you have any other substance use disorders, psychiatric disorders, or medical conditions that may influence your AUD treatment.
Naltrexone is a safe medication that has been prescribed for decades, but, like all medications, it has potential side effects and drug interactions. Common side effects associated with naltrexone use include:
- Abdominal pain or cramps
- Anxiety
- Constipation
- Difficulty sleeping
- Dizziness
- Fatigue
- Headaches
- Insomnia
- Joint and muscle pain
- Low energy
- Nausea
- Nervousness
- Vomiting
In clinical trials, over 10% of people taking naltrexone experienced these side effects.
Naltrexone has an FDA box warning for liver damage. If you have a history of hepatitis or liver failure, you should not take naltrexone. Naltrexone may increase your risk for depression or suicidal ideation. Tell your doctor if you are pregnant or planning to become pregnant before taking naltrexone.
Consuming alcohol with naltrexone can increase nausea and vomiting. Because naltrexone binds to opioid receptors, it is very important to not take any opioids, illicit drugs, alcohol, sedatives, tranquilizers, or other drugs when taking naltrexone. Taking naltrexone within 7 to 10 days of taking opioids can precipitate serious withdrawal and other adverse effects.
Because of the stigma associated with AUD, many people who desire treatment are not receiving it. Start with your primary care physician or online telehealth physician. Explain your concerns about your alcohol use and ask for treatment.
Many medical professionals are not fully educated in treating AUD, and many patients are not aware that treatment for AUD exists. If you do not get the treatment you need, ask for a referral to someone who can help.
References
- Carpenter JE, LaPrad D, Dayo Y, DeGrote S, Williamson K. An Overview of Pharmacotherapy Options for Alcohol Use Disorder. Fed Pract. 2018 Oct;35(10):48-58. PMID: 30766325; PMCID: PMC6248154.
- Han B, Jones CM, Einstein EB, Powell PA, Compton WM. Use of Medications for Alcohol Use Disorder in the U.S.: Results From the 2019 National Survey on Drug Use and Health. JAMA Psychiatry. 2021;78(8):922–924. doi:10.1001/jamapsychiatry.2021.1271
- Swiatek, D., BS, PharmD Adjunct Assistant Professor SUNY UB School of Pharmacy, Pharmaceutical Sciences Director of Clinical Research Pharmacy Services CTRC-Clinical Research Center Buffalo, New York Nicholas A. Bosso, & Candidate, P. (2018, August 17). Naltrexone for the Treatment of Alcohol Use Disorder in the Primary Care Setting. Uspharmacist.Com. https://www.uspharmacist.com/article/naltrexone-for-the-treatment-of-alcohol-use-disorder-in-the-primary-care-setting
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