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Date: 27 Jul 96 16:55:02 EDT
From: "Furey A. Lerro" <71544.3434@compuserve.com>
Subject: Naltrexone in alcoholism
I have not seen naltrexone (Revia) to be very effective in the few patients that I have tried the medication with.I haven't found naltrexone too useful either. The proposed dual action that the company touts, i.e., cutting craving and eliminating euphoria when alcohol is taken, seems to result in the latter, but not the former, in those I have used it with. People tend to skip their morning dose and drink if they want to override it.
From: "Joseph R. Volpicelli" <volp@cattell.psych.upenn.edu>
Subject: Naltrexone in alcoholism
Date: Sun, 1 Dec 1996 19:12:46 -0500
I first used naltrexone in the treatment of alcohol dependence in 1986 and have now tested the effectiveness of this medication in about 280 patients, about half randomized to placebo. Also, I have used naltrexone clinically in non-research studies on over 200 patients. In general, I find naltrexone to be safe (even in patients with hepatotoxicity) and remarkably free of side effects (about 10% of patients experience nausea and stop the medication). Naltrexone when combined with psychosocial support reduces relapse rates by half and reduces alcohol craving in many patients. The main limitation of naltrexone is treatment compliance. Among patients who are compliant with taking medication and attending clinical visits, naltrexone has a treatment effect size of about 0.7 relative to similarly compliant placebo patients. This compares favorably to the use of antidepressant medications which have treatment effect sizes between 0.4 and 0.6.
While there clearly needs to be more clinical experience to identify those patients likely to be helped by naltrexone and the most effective duration of treatment, my recommendation at this time is that patients should have 6 months of sobriety before the medication is stopped. Given the safety and clinical efficacy of naltrexone, I suggest that naltrexone be offered to all alcohol dependent patients who present for treatment.
In the interest of full disclosure, I should point out that I have received funding from the NIAAA to conduct my research and have received consulting and unrestricted educational funds from Dupont Pharma. The views I have expressed here reflect my personal opinions and should not be seen as reflecting the views of the NIAAA, Dupont Pharma, or my university.
It seems that the field has underutilized this safe and effective medicine and I fear we are withholding an effective adjunct to treatment because of personal bias, not scientific data.
Date: Sun, 1 Dec 1996 21:12:40 -0500
From: bret burquest <bret@vnet.net>
Subject: Naltrexone in alcoholism
I've given naltrexone to 3 alcoholics. One required 150 mg/d for persistent effect. One found it helpful to resist drinking when he wanted to resist, but stopped it when he planned to drink. He couldn't say whether it helped cravings. The last said it bothered her and requested disulfiram. She relapsed within a few weeks.
Date: Sun, 01 Dec 1996 23:05:30 -0500
From: "Paul Luisada, M.D." <pvl2@cornell.edu>
Subject: Naltrexone in alcoholism
Two patients have had positive experiences. A 40-ish female unable to maintain over five days of sobreity when not hospitalized remained sober for over a year. She lasted 2 months after stopping the naltrexone and has made it another 6 months so far mostly without it. A 40-ish male hospitalized for suicidal ideation requested a prescription for it in case he couldn't stay in the Salvation Army's residential program after discharge, saying it "always worked" for him and was worth the $7.00 per day.
Two others have not found it helpful.
From: "Joseph R. Volpicelli" <volp@cattell.psych.upenn.edu>
Subject: Naltrexone nausea
Date: Tue, 25 Feb 1997 20:12:47 -0500
I tried a fellow on naltrexone once who had been abstinent 24 hours and he had a full-blown Jones from it! It lasted for days, and led him to admit himself for detox.Typically I wait until a patient is off alcohol for at least 72 hours before beginning naltrexone. Stephanie O'Malley has data suggesting nausea and possible naltrexone precipitated withdrawal occurs only for alcoholics who are smokers.--John M. Rathbun
From: "Joseph R. Volpicelli" <volp@cattell.psych.upenn.edu>
Subject: Naltrexone nausea
Date: Tue, 25 Feb 1997 20:19:08 -0500
About 20% of my alcoholic patients experience nausea in the first week of treatment. Usually taking the dose at night helps relieve symptoms. Only about 5% of patients find the side effect too intolerable to continue treatment.
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Dr. Bob is Robert Hsiung, MD,
dr-bob@uchicago.edu
URL: http://www.dr-bob.org/tips/split/Naltrexone-in-alcoholism.html
Original tips copyright 1994-97 original authors.
Web page copyright 1995-97 Robert Hsiung.