I have started using namalfene and am confused. My drinking is very routine: 3 AF days a week, then of the other 4 days some I will be at home so will drink 2 large beers and half a bottle of wine. Maybe too much but I can live with it although would prefer not to be completely unable to vary from this routine. But the reason I wanted to try to cut down is that if I go out any of the 4 days or have friends round then chances are I will go totally over the top and get really drunk. Those are the episodes I want to correct. My question is - on the drinking days when I am home, do I have to take the pill? I know without a doubt I won't drink more than my usual amount. The namalfene makes me feel very tired and spaced out and is expensive ( live in the UK and buying online), so I don't want to take it when I don't need to. Any advice welcome. Thanks very much.

hi Debs

welcome to the forum

you need to take the pill an hour before EVERY TIME you drink alcohol. any time you drink without a pill you're allowing your brain to re-learn the dopamine "buzz", which is what we're trying to un-learn by taking Nal

it sounds like you've just started on Nalmefene. the side-effects - tiredness, spaced-out-ness, nausea, etc. - do lessen, often to nothing, over the first few days/weeks of taking it. do try to stick with it, the end result is worth it!

all the best

-badger

No, TSM is not recommended for intermittent use. For it to have it's intended effect, you have to take it an hour before you drink, every time you drink, for as long as you continue to drink. Questions such as yours come up fairly often, but there really are no "ifs, ands or buts" about the golden rule, and the primary reason it doesn't work for some people is a lack of 100% compliance.

The good news is that it sounds like you are taking steps and intervening at an early stage in something that could get much worse if you don't take positive action.

From What I've read the initial SEs from Nalfemene are greater that Naltrexone, but with with both (for most people) the SEs become less apparent.

Thanks very much for the replies. I will be taking namelfene for the next 4 days as will be drinking so will be interesting to see how the side effects are. It seems strange that as a small slim woman I take the same dose as a tall heavily built man. I am quite susceptible to the effects of drugs and medication for instance if I were to take a Nytol I would only need a quarter for it to work.
I know this will sound strange but I am worried about not being able to have any evenings of enjoying moderate drinking. It is part of my social life and culture, I dont want to be the one drinking water and leaving early. That's why I was asking about always having to take it, not only on the really heavy drinking days. Thanks.

I understand your question and sympathize.

In the end you have to weigh the risk against the reward and decide what's best for you, but unfortunately with TSM you can't have it both ways. For some of us the risks are stamped on our foreheads and it's a clear choice, but for others no doubt it's more a shade of gray.

most people find that they are able to drink moderately after taking Nal, if they wish to, so I don't think this should be a problem for you

Dear Deb,

Moderation possible, yes! Abstinence possible, yes! Continuing the way you were, yes! The choice becomes clear after you've followedv TSM awhile.

For over a year, I have been drinking in the range of 10 to 15 units per month , over 20 AF days every month. ( but who's counting !) That compares favorably to a previous of in the 250 range for many years.

Anyways, during social situations or dinner, a drink or 2 is fine and usually occurs, but getting drunk, out-of-control never occurs.

What naltrexone takes away is the compulsive urge to keep drinking, and the delusional belief that is a good thing.

It also makes craving alcohol and urges a thing of the past, (indifference), and allows you to focus on the good things in life.

Even better, I'm never the the one drinking nothing but water, or having to explain why I'm "not drinking". Or "What's up with that? ".

So it is a good result. You might say I've gotten my life back.

TSM is not a treatment for individual drinking sessions, it is a long term process. Not taking it everytime you drink alcohol hinders the benefit obtained. You have to want to reduce your overall drinking, and doing so has to be more important than having the pleasureable sessions.

As your desire to drink wanes you might find yourself reconsidering your stance on alcohol, friends may change or reduce their drinking, alcohol may stop being the centre of your social life. I go home early because I want to, it was only wanting to drink more, get more drunk that had me stopping out late, I thought it was to connect with people. I now know that was a lie and excuse and I spent many evenings talking a load of codswallop thinking I was being brave and interesting.

Regards size of person, why should a drug be based upon bodyweight?

Everyone assumes drug dosing is related to bodymass, but in this case the medication is simply covering receptors in the brain.

I have been told that many medications for things such as state of mind, depression, even alcoholism were not discovered nor developed on any sort of scientific, solution providing basis. It was simply noticed that they had the effect of whatever, and dosage developed from empirical observations. In other words 'such and such a dose works best for people who are this size/age/weight/diagnosis'.

We are so used to things being dosed per kg of bodyweight that we think it applies to everything.

Is the contraceptive pill prescribed on a bodyweight basis?no it is not. Slender women take the same hormones as those twice their bodyweight.

Thank you - such interesting answers. Point taken about dosage, just had noticed posts talking about the other medication where people were taking half doses etc.
I can see that I am embarking on a journey here, really not sure what to expect. Haven't really noticed a difference yet but it's early days and I haven't been really tested yet. All this advice is really helpful.

Hi there - I do not think I can say anything much that hasn't been said by everyone else - you MUST take the Nal every time you drink! I too am slim, and cannot even take antihistamines 'cos of the effect they have on me - I am so susceptible to meds, but with the Nal, as long as I have some food in my tummy I am fine - today I took it on an empty tum and had nausea!

You said that you like the feeling you have when you go out - hence not wanting to take it on those days - but the whole idea is to retrain your brain - so yes, take the Nal and then go out - why did you say you would have to be drinking water ?

It is early days for me too - three weeks in - but I am seeing a slight change - not every day but definitely some days ! It is an odd feeling - hard to describe, but the Nal is doing something !

Good luck with it ... let us know !

hugs, Maggie