Naltrexone for Compulsive Sexual Behavior

Introduction to Naltrexone

Naltrexone is FDA-approved exclusively for opioid dependence and alcohol use disorder, but not for compulsive sexual behavior or any behavioral addiction, according to the American Academy of Pediatrics and the American Academy of Family Physicians 1, 2

The mechanism of action of naltrexone involves blocking mu-opioid receptors, which dampens activation of the brain's reward pathway and reduces cravings for addictive behaviors, as described in medical guidelines 3, 4

Oral naltrexone 50 mg daily is a typical starting dose, and alternative dosing of 100 mg on Mondays/Wednesdays and 150 mg on Fridays can be used, as suggested by medical guidelines 4
Extended-release injectable naltrexone (Vivitrol 380 mg monthly) may improve adherence, but its use for this indication has not been specifically studied, according to medical guidelines 3

Patients must be completely opioid-free before starting naltrexone to avoid precipitating severe withdrawal, and liver function tests should be monitored at baseline and every 3-6 months due to potential hepatotoxicity, as recommended by medical guidelines 3, 4
If the patient requires opioid analgesia for surgery or injury, oral naltrexone must be held 2-3 days prior, or 24-30 days for extended-release formulation, according to medical guidelines 3, 5