If I was drinking during the day, say going out for lunch then drinking in the evening I'd take 50mg 1 hour before first session, then 25 or 50mg in the evening. The reason I did this was that I understood that the half-life of naltrexone is 4 hours, so after 4 hours you only have half a dose in your system, and for me I'm overly cautious and wanted to make sure I had all receptors covered. Might have been overkill!

Actually, the half-life of the active metabolite in naltrexone is 13 hours. Therefore adding a second dose provides no value, while adding an expense. Here is Eskapa's comment on the matter, from Joanna's blog.

Eskapa:

"The plasma half-life of naltrexone is about 4 h, and for its active metabolite 6-β-naltrexol it is 13 h.

"Therefore one 50 mg tablet of naltrexone blocks opiates and endorphins for at least 24 hours.

"More is not better. For example, to control heart rate by taking the beta blocker propranalol or atenalol in higher doses than the maximum recommended dosage will not block adrenaline any more effectively. So taking 200 mg naltrexone is not more effective than the recommended 50 mg dose.

"The half life of Nalmefene is longer, so again more is not better."

Naltrexone's controlled clinical studies are so remarkable that I think we have to acknowledge that the likeliest cause of the protocol's failure is noncompliance. We're fortunate in that Eskapa has written so extensively, and so plainly, about the protocol. There is no ambiguity in his recommendation to dose at 50 mg/24 hours, and not to bother with 'booster' doses.

BuenaVista,
Out of interest, has Eskapa written anything about some people needing higher doses? I know that for some folks who aren't seeing results there's suggestions on here to increase to 75 or 100mgs. Has that been addressed at all? Thanks. Ruth.

Not to my knowledge. His writing sticks to 50mg/24 hours.

Not in the book. In [url]The Cure for Alcoholism[/url], he writes that some need higher doses to reach 100% blockage of the relevant receptors.

Barryb-

I'm not sure i drink 10 units per day. It varies. I definitely drink 1.75 of smirnoff every 6 days and in between probably 5-8 glasses of wine per week and maybe 1-2 beers. I just find the urge around 11am when my nerves seem to kick in.. I've been taking Nal everyday around 11am per the advice of this board for the last three-four weeks.... hoping it will last til 10 pm. I never get drunk, just use the vodka to calm my nerves. I take the xanax occassionally but it doesn't seem to help, just makes me tired at night and fall asleep.

The first week on nal I drank less. But I think you are right, I have created a loop of anxiety over drinking. I think about it, it causes anxiety since I realized my problem, then I take a few sips of vodka (secretly of course) to calm my nerves, and since I take nal at 11am it says you have to drink. All the info says it takes 3-4 months minimum to work, so I am just trying to follow my pattern and hope that in a few more months I am feeling less cravings and more in control.

People would be shocked to know I have this problem. Lately though ....the last year, I've definitely had memory loss- amnesia from about 8pm til bedtime. I'm not noticeably intoxicated to anyone, but my memory is failing, and if I don't drink a little alcohol by noon, I am shaking. This scares me terribly, which is why I researched all the books and found out about nal and other vitamin regimens.

For reference, I am 40, 108 lbs, and last year got life insurance at the lowest rate possible for a 1 million dolllar policy...(with full blood testing)....so for some reason my organs are not yet affected and my blood work is not showing I am an alcoholic, but I know I am. I do yoga everyday and swim and hike 3-4 times per week. I haven't been able to test the non-nal days yet with regard to saving an activity I love, like yoga or paddleboarding for non-nal days, because I am not there. Just hope I am doing this right and the nal is still in my system when I have a drink at 8pm....otherwise I feel I am doing the opposite of the program. Patiently waiting and following my drinking patterns for the next few months, to see if there is a gradual change. Thank you all for the info. Much love and gratefullness to this board, Eskapa, and Nal. I pray to God every night it will work for me.

Olive

I'm not sure I understand you. You take nal at 11:00 AM hoping it will last until evening, and then you feel like you have to drink at noon because you took the nal? Or you take nal at 11:00 AM (for reasons I don't understand) and then don't drink until 8:00?

FWIW, it does sound like you're reaching ten units. American units are small -- you said you were in the USA, right?

Melissa,

I am in the USA - so maybe am reaching 10 units. I feel the urge to drink around 11am-noon- so I take it then. But the rule is take nal 1 hour before you drink so then i drink a little vodka to calm my nerves 1 hr after i take the nal. My understanding is you have to drink after taking nal, so as to slowly build up the blocking of the receptors....so just been following my same drinking pattern after taking the nal and hoping in a month or two my cravings will be minimized to where i don't think about alcohol at all and my nerves have slowly recovered to a normal state and the shaking stops. Just hoping to gradually reduce my alcohol intake and wean myself off alcohol without going cold turkey. Make sense?

But yes I drink small amounts of vodka all day hourly from about noon to 10pm. Not enough to be noticeably intoxicated but to calm my nerves. I swim, hike, do yoga, paddle board all while drinking small amounts of vodka a day. So embarrassed but it is become a way of life to dealing w stress of an ex husband who stopped working, and who finally recognized his ocd ( my son and I walking on eggshells fo years and we could never do anything right, he cleaned nonstop, takes five showers a day, and then started training for Ironman competitions ...training 4 hrs per day.... and abandoned his family)....which clearly affected my self esteem. I don't believe in divorce so with Christian therapy I hung in there as long as I could....but to cope the financial stress, etc I began drinking to calm my nerves. After several years of a separation, I finally realized I could not be w this man and make my marriage look like my parents who have been married 48 years.

Instead I now acknowledge I have this problem and doing my best to fix it on my own. HE or my son know nothing of it. I just want to fix it and start over with my life. hope you understand. I believe this system will work, but I want to make sure i do it properly and there are no doctors in my area that use the Sinclair Method...so winging it at this point.

Olive

You don't have to drink. The naltrexone itself blocks the opioid receptors, so that any drinking you do won't provide reinforcement to the habit. The blockage doesn't grow with alcohol; the nalrexone provides blockage which interrupts the normal effects of alcohol.

Maybe it would make more sense to think of it as "don't drink unless you have taken nal an hour beforehand"?