Wow Server I am sorry to hear you get so sick on the Nal. I can tell you that I don't take it on an empty stomach as it always causes nausea. I have noticed increased nausea throughout the day since I started taking it on 12/1, but I can live with it. I hope that you get better. I did notice several people using 25 mg. rather than the 50 mg, and they still had success, so that is probably not a big issue. Keep us posted. We need to hear from you.

Cindy.

Hey Server,

I am so sorry to hear about your terrible SEs. I don't have any good advice as (fortunately) mine subsided after a few days. However, I remember that minneapolisnick had trouble with SEs and was ultimately cured. So you might learn something by taking a look at his old posts. Just a thought ... good luck!

YG

Server, sorry to hear you are having such a rough time with SE's. I didn't have any nausea past the first couple of days but having read about others struggles definitely take nal with food and maybe 2 hours before you anticipate drinking. I have included an abstract from a study on nausea and naltrexone. The researches concluded that extended alcohol use may be altering the endogenous opioid (endorphin) system. I have often wondered about this because although naltrexone blocks endorphins in the brain it doesn't necessarily block their effects in other areas of the body (like the stomach). If blocking your brain's opioid receptors were to cause receptor upregulation or additional release of endorphins this could affect other areas of the body. It's not unusual for people to become nauseated or vomit after strenous exercise due to the endorphin release so something similar may be at work with naltrexone. Well I hope it gets better for you because you were responding.

I had to time to read this article more closely and gleaned a couple of things from the authors. Keep in mind this study was on 50mg daily naltrexone with prior abstinence but continued drinking during the study so not exactly TSM.
-Younger patients were more likely to become nauseated than older
-Women were 7.2 times more likely than men to experience nausea

The authors take on this was

The only practical advice they offered was

Again they were not using TSM here so I'm not sure how well this applies to you but if you are miserable with side effects and it is jeopardizing your compliance it might be worth a shot. I was surprised they didn't offer the simple and common sense advice of taking naltrexone with some food in your stomach.

Good luck Server.

I'm totally with you on the side effects! I'm a lightweight female, 40. After hitting all those bottoms that AA refers to (lost job, license, friends, etc), I went on Campral years ago and got my drinking to weekends only, though when I drank, I was out of control. And when I drink, I have withdrawal the next day so I was dosing with Valium the next day or two so I'm a bonafide alcoholic, not a problem drinker. I also couldn't have anything in the house during the week. After ruining our vacation this past summer by starting drinking mid-day every day (and subsequently passing out or making an ass of myself), I decided to look into options and found this site. I bought the book.

I bought NoDict (Nal - Indian version) from River. The spontaneous vomiting at 25mg was horrid. I noticed that if I took it (and drank) 3 days in a row, by the 3rd day, I wasn't vomiting. It's made a huge difference in the amount I drink (from a large bottle of wine to a small now, in an evening) and I don't get the frantic NEED MORE NOW. Sometimes I'm okay with having booze in the house, some days I give in when I shouldn't. However, if I go the whole week without, take one Friday/drink, I'm puking up the first drink and sometimes don't make it to the bathroom. Last night, I had that feeling after taking it so I drank half a glass of wine before we went out because too many times I've thrown up the first along with my food while out to dinner. I threw up before we went out and afterward I was fine. I started drinking/Nal mid-week one day to see if it would help keep my body used to it and it's worked somewhat. The most I've managed is half a 50mg + 1/3 of the other half. Ironically, it seems that if I drank daily, my stomach would deal with the Nal. A few days without and I'm puking. Like you, I've had days that I've been curled up in bed, puking, sweating, shivering the next day - worse than a hangover. I would like to up my dose to be more effective but I haven't been able to. I think I bought them in August and was just going to order more but River's site seems to be defunct and when I googled, I ended up here again and thought I'd see if others were experiencing the same side effects. My fiance is happy with the new me but he also hates the loud projectile vomiting... but he'd rather that than the me from 3 years ago, being rushed to the ER for alcohol poisoning at 10am!

I've lost more than 10% of my body weight since I've been taking Nal (127# to 112#). There are days I'm not hungry til 3pm the next day, or just nauseous. I'm sure it's not all from Nal as I started at the gym 4 months ago too but I attribute the toning to the gym, the loss of weight (which I really didn't need) to the Nal. I prefer myself at this weight and did want to lose it but puking wasn't what I had in mind.

Try riverpharmacy.ca they changed it from .com to .ca
Dave

Week 15 is over and the very first time I've gotten under 30 units in a week! Still no AF days lately; but I feel that they are on the horizon. Also still at 25mg; cannot get up to 50mg, but still very happy with my progress. My new strategy is portion control, much like dieting. I drink white wine, same type, everyday. My glass holds 10oz, which is 2 units, so I've started keeping the bottle warm and out of the fridge. I fill my glass with ice, at least 7 cubes, and then the wine only takes up half the glass. I let it melt and it feels like a full glass, but is essentially half water. I repeat this each time I go back to the bottle. I make sure to measure out the wine first, so I know that I'm not pouring more than 5ozs. My goal this week is to move from 4-5oz glasses to 3, and to add an AF day if possible. I've felt better than I have in a long time!

Server - So glad to hear from you. Great progress for you too. I am shooting for 4 - 5oz. glasses of wine next week and I may try your trick with the ice. I have been stuck at 5 - 5oz. glasses of wine for a couple of weeks now.

Good luck trying it. The key is not to think of the full glass with ice as only half a glass. It is a full glass. Also, if you give it time for the ice to melt, you are slowing yourself down each time and you have to sip around ice, so no large gulps.

Let me know how it goes!

Another week down and still lower numbers. I feel like I'm at my plateau; able to stay between 3-3.5 units per night, but still unable to do an AF day. I am working so hard at trying to get my nightly numbers down low enough that I will eventually have the courage to do an AF day. My goal this week is to get as close to 20 units as possible. My end goal is to be under 14 units per week, control over whether I take a drink or not, and an ability to do AF days without anxiety. I am happy that I am down from pre TSM levels of 70 units or more a week, to 23 units last week, but I still have more work to do. I get a lot of encouragement from others and hope that patience will be rewarded. I am still doing this on 25mg; the side effects have eased up, but not sure if I should try the 50mg or not. If I've come this far on 25mg, do I need the 50mg? Anyone out there experimented with dosage levels?