Naltrexone for Smoking Cessation

Introduction to Naltrexone Therapy

Naltrexone alone is not recommended as a primary treatment for smoking cessation, but may be considered as part of combination therapy with bupropion in patients who need both smoking cessation support and weight management 1, 2, 3, 4

The combination of naltrexone and bupropion has shown more promising results for smoking cessation than naltrexone alone 1, 2, 3
Limited data on smoking cessation with the combination of sustained-release bupropion and naltrexone showed a reduction of nicotine use and mitigation of associated weight gain 1
A study investigating the addition of naltrexone to bupropion demonstrated superior efficacy with the combination therapy at 7 weeks of treatment, though equivalent relapse rates were seen at 6 months after treatment termination 1

Naltrexone is an opioid antagonist that should not be used in patients requiring short-term or long-term opioid therapy 1, 5
It must be discontinued before procedures requiring opioid analgesia to prevent reduced analgesic efficacy or precipitated withdrawal 1
Liver function tests should be monitored at baseline and every three to six months due to potential hepatic injury at supratherapeutic doses 6

For patients with both obesity and tobacco use disorder, naltrexone-bupropion ER may be considered as it addresses both conditions 1, 7
The American Gastroenterological Association (AGA) suggests using naltrexone-bupropion ER with lifestyle modifications for weight management in patients attempting smoking cessation 7
The combination may be particularly beneficial for patients who experience weight gain during smoking cessation attempts 1

Blood pressure and heart rate should be monitored periodically while taking naltrexone-bupropion ER, especially in the first 12 weeks of treatment 7
Naltrexone-bupropion ER should be avoided in patients with seizure disorders and used with caution in patients at risk of seizures 1
Long-term cardiovascular safety of naltrexone-bupropion ER remains unclear as cardiovascular outcome trials were terminated early 1

Bupropion alone is FDA-approved for smoking cessation and may be considered before adding naltrexone 8