Naltrexone Dosing for Compulsive and Self-Injurious Behaviors

Maximum Documented Doses in Clinical Studies

The highest naltrexone doses studied for self-injurious behavior in individuals with developmental disabilities reached 100 mg/day, with most studies using 50 mg/day as the standard therapeutic dose 1
The standard dose of 50 mg/day was most commonly studied in autism spectrum disorder populations, with treatment durations ranging from several weeks to months 1
Weight-based dosing of 1 mg/kg/day was used in pediatric studies for children aged 3-8 years with autism and associated behavioral problems 1

Liver function tests must be performed at baseline and every 3-6 months during naltrexone treatment, as hepatotoxicity can occur at supratherapeutic doses 2, 3
Naltrexone is contraindicated in patients with acute hepatitis or liver failure 2, 3
Patients must be completely opioid-free before starting naltrexone to avoid precipitating severe withdrawal symptoms 2
Naltrexone cannot be used in patients requiring opioid analgesics for pain control, as it blocks pain relief from opioid agonists 2
Patients who discontinue naltrexone have increased risk of opioid overdose and death due to decreased opioid tolerance 2

For children (3-8 years): Use weight-based dosing of 0.5-1 mg/kg/day 1
For adolescents and older children: Consider 50 mg/day as used in autism studies for ages 5-19 years 1
Repeat liver function tests every 3-6 months 2, 3
Assess behavioral response weekly during initial titration, then monthly once stable 1
Monitor for common side effects including headache, tachycardia, vivid dreams, nausea, and gastrointestinal symptoms 3