I am so glad to hear this, very happy that a dosage increase can be so effective. The "50 mg is the magic number" thing has always seemed so over-simplified to me. I think I might be in a similar situation as you. Increasing my dose by 25% wasn't enough...maybe I need to be taking 75 or 100 mg. I need to get the support of a real doctor on this so that I can keep an eye on the health of my liver as I push the dose higher in search of that goal I've been striving toward for so long.

I keep reading about people's concerns about their liver with Nal... is it harder on the liver than other meds? Or than the alcohol we've been drinking?

My understanding is that it's not all that hard on the liver, but long-term heavy drinkers may already have liver damage, so some people want to be safe.

Maybe that's why the recently approved protocol recommends nalmefene instead.

Week 0: 72 (before TSM)
Week 1-4: 63, 57, 69, 50
Week 5-8: 73, 43, 57, 56
Week 9-12: 47, 59, 55, 61.5
Week 13-16: 59, 65.5, 58, 57
Week 17-20: 59.5, 69, 71, 66
Week 21-: 56, 70

No good news to report, really. I'm back up to 37.5 mg. Current 7-day running average is 10.3 drinks/day. Still haven't gotten around to making that doctor's appointment. Overall TSM motivation/optimism is at an all-time low. I don't really have any other options left, though, so I'm still taking the pills and hoping that eventually something magical will happen and I won't want to drink every single night anymore.

Oh, boy. Ives, may I suggest that you try nalmefene? You're getting too many side effects to take as much naltrexone as you need for extinction. Clearly you need to do something else.

Your way-too-long half-life also makes me think that naltrexone may not be the drug for you. I don't know if your liver isn't up to processing it correctly or if you're just abnormally sensitive to side effects, but either way something's wrong.

If you really want to stay with naltrexone for some reason, you could try a baclofen boost. Some people use baclofen to kill cravings and let them have AF days, then wean from baclofen as extinction makes that possible. I'm really worried about you and the naltrexone, though. That's not normal.

I'm not going to suggest that you just plain abstain, since you wouldn't be here if that were simple for you, but I guess it would be possible to go to a rehab which would force detox and temporary abstinence in order to get a boost. Schick Shadel? That place in Florida which does inpatient Sinclair under a doctor's supervision?

No matter what you do, please stay in touch. I am a big worrywart who will fear that you're dead or in prison if you just disappear.

Nalmefene would be just lovely to try, but it's not approved to be prescribed for alcoholism the US, and is not available from online pharmacies. The thought has crossed my mind that I should give up on naltrexone wait until I can get a prescription for nalmefene.

Baclofen is a no-go, I've got a ton of it on hand because I spent several months taking it, and the side effects are absolutely insane. And it did not reduce my drinking at all, even at an extremely high dose. Not to mention that you become heavily physically dependent on it, and if you somehow lose access to it, you go into intense and potentially dangerous withdrawals.

Schick-Shadel is a really awful aversion therapy which is basically controlled torture. It seems to be effective, but I am not willing to do it, not in the slightest. I have read first-hand accounts of what it is like to go through that treatment and I could never subject myself to that.

I have a really successful career with a company that I want to keep working for, and I can't just up and move away somewhere to seek treatment. I can't get another job like the one I have if I throw this away. If there is a way out for me, it will have to be something I can do while still continuing to keep up with my job and staying in the same city.

Ives,

The higher dosage is definitely a requirement for me. After I posted that I had increased the dosage I dropped back down to 50 MG and I could really tell the difference. I really felt the effects of alcohol and I think I back slid a little bit as a result of reducing the dosage. I also violated the one hour rule a few times and drank a few times without taking NAL. I'm seem to be paying for that now as my intake has increased and I'm not having any AF days. I initially had a liver test done when I first started the medication and it showed that it had no effect on me. Maybe you can do the same? I get my prescription from a psychiatrist and not my regular GP. I have not discussed TSM with him. He thinks I am taking it as it was originally intended. Good luck and have a great week.