Long article about treatment with Naltrexone

http://www.assistedrecovery.com/beta/news.htm

Quote:

Dose Matters

The usual starting dose of naltrexone is 50 mg/day, but some patients are started at 25 mg/d. Dosages may be increased up to 100-150 mg/d until cravings are eliminated. Vacovsky notes that, although initial studies of naltrexone for alcoholism used a 50 mg/d dose for only 12 weeks, experience has shown that the 100 mg/d dose for 6 months seems to be the most effective. Interestingly, he has found that women often need higher doses than men.

Timing of the dose can be important. "Patients should take the medication at the time of day when cravings usually begin to appear," Vacovsky advises. "For some, it's first thing in the morning, for others it may be when they leave work the 'happy hour syndrome.'"

Patients are not required to detox before entering the program, but Vacovsky prefers that they be sober for up to 5 days, which reduces the incidence of potential naltrexone side effects. The most noticeable side effect appears to be fatigue. Nausea, headaches, and tremors can also occur; however, Vacovsky believes such symptoms are more often due to prolonged alcohol withdrawal.

He stresses that it is important to start treatment immediately when the person is ready, rather than expecting prior abstinence. "Naltrexone actually has a positive effect on detoxification, making it more bearable and allowing patients to be more functional."

Patients are instructed not to drink while on naltrexone. Although, Vacovsky concedes, nearly three quarters of them do drink to test the effectiveness of naltrexone. "They find that naltrexone indeed works to dull the effects of alcohol and rarely will they even finish the first drink."

What that report ought to state is "Although, Vacovsky concedes, nearly three quarters of them reported that they do drink to test the effectiveness of naltrexone." It's probably closer to 90% of them in reality.

Interesting study. Thanks for the research.

Bob

This type of study is why meta analysis sheds light on the true value of naltrexone. So many studies treat it as a short-term anti-craving drug. How much would you want to bet that six months at 50 works just as well as six months at 100? And the sad part is, the poor subjects were not told to stay on naltrexone, so a followup would have shown they had "relapsed" after several months. Meta analysis of many studies has revealed that the true value of naltrexone comes from combining it with drinking. Subjects in many studies who were non-compliant with abstinence showed fewer drinking days and lower consumption long-term.

We went through a round of "Do women need more?" a few months ago. My concern was that the alarm was raised based on a single study that was attempting to use naltrexone as an anti-craving drug.

The fact that this drug is so misunderstood has a great deal to do with the politics pf the pharma industry. Eskapa discusses it in the book. Here's a link to a post by me about it.
viewtopic.php?f=12&t=537

To me this article is worthless because it starts from the premise that naltrexone should be taken as an anti-craving drug. As Lena and Eskapa and Sinclair, as well as all of the recent studies show, NALTREXONE IS ENTIRELY INEFFECTIVE WHEN TAKEN WITH ABSTINENCE. Accordingly, I don't trust a single conclusion that follows if the entire premise of the article is so far off the mark.

All of them ever except maybe one.