Naltrexone

Aka: Naltrexone, Trexan, Revia

1. Indications
   1. For relapsing Alcoholic
   2. Must be used with an aftercare program
2. Contraindications
   1. Long-term Opioid use or heroin dependence
      1. Risk of severe withdrawal
   2. Hepatitis
   3. Liver failure
3. Adverse effects
   1. Hepatotoxicity (dose dependent)
   2. Nausea (10%)
   3. Headache
   4. Anxiety
   5. Sedation
4. Mechanism
   1. Reduces Alcohol craving
5. Efficacy
   1. Initial studies showed relapse reduction by 50%
   2. Recent large DBPCT showed no benefit with Naltrexone
      1. Relapse rate: 38% at 13 weeks (44% with Placebo)
      2. Compliance rate low: 42-44% in all groups
      3. Krystal (2001) N Engl J Med 345:1734-9
6. Adverse effects
   1. No toxicity if drinking with Naltrexone
      1. Not indicated to make them social drinkers
      2. Alcoholics tend to get less drunk on Naltrexone
   2. Very broad safety profile with minimal adverse effects
      1. Hepatotoxicity, however is a risk
      2. Croop (1997) Arch Gen Psych 54:1130-5
7. Monitoring
   1. Obtain serum liver transaminases periodically
      1. Monthly for first 3 months
      2. Then every 3 months
8. Dosage
   1. Naltrexone 50 mg PO daily ($5/pill)
   2. May need to be used for 1 year or longer
9. References
   1. Hartmann (1997) Am Fam Physician 55(5):1877-9
   2. Williams (2005) Am Fam Physician 72(9):1775-80