Naltrexone Treatment for Alcohol Dependence

Introduction to Naltrexone Dosage

The recommended dose of naltrexone for treating alcohol dependence is 50 mg once daily orally, or alternatively as a 380 mg monthly intramuscular injection, as recommended by the Hepatology society 1, 2

Extended-release injectable naltrexone (Vivitrol) is administered as a 380 mg intramuscular injection once monthly, with potential improvement in medication adherence compared to daily oral dosing, according to the Hepatology society 1, 2

Naltrexone functions as a competitive antagonist at mu opioid receptors, blocking the euphoric effects of alcohol and reducing cravings, as described by the Praxis Medical Insights society 2
The number needed to treat to prevent return to any drinking is estimated to be approximately 20 for naltrexone, with an effect size in the 0.15 to 0.2 range, as reported by the Hepatology society 1, 3

Naltrexone undergoes hepatic metabolism and has potential hepatotoxicity concerns, though this is uncommon at the standard 50 mg dose, according to the Hepatology society 1
Liver function tests should be performed at baseline and every 3-6 months due to potential hepatotoxicity at supratherapeutic doses, as recommended by the Praxis Medical Insights society 2

Naltrexone has not been specifically studied in patients with alcoholic hepatitis or alcoholic cirrhosis, and acamprosate may be a safer alternative for patients with liver disease, as reported by the Hepatology society 1, 3
Naltrexone cannot be used in patients requiring opioid medications for pain control, and oral formulations should be held for 2-3 days prior to elective procedures if opioids are expected, according to the Praxis Medical Insights society 2