Sounds like good advice JSP. I wish I could help too.
Hang on in there
MD

Hey all -

Heading into week 12 now, numbers are riding a bit under of 50% pre-TSM (38/wk vs 84/wk), so still doing ok and not worried about the rise from earlier weeks. Haven't felt like going for an AF day yet and still not sweating about that.

50mg proved to be too much for me, the SE's were just too difficult to work with (left/right balance problems, mainly). Sticking with 25mg for now and haven't seen any rebound in the numbers from that. SE's are much, much easier to live with here, so unless I see a sustained increase I'll be staying with that dose for at least a month. So here come the numbers:

Week/Units/AF
1.....58.6.....0
2.....51.9.....0
3.....36.6.....0
4.....31.3.....0
5.....30.0.....0
6.....31.9.....0
7.....38.0.....0
8.....26.1.....0
9.....27.7.....0
10...40.4.....0
11...38.1.....0

Thanks for all the support and for sharing your journeys with me!

Hey JSP

Well done - I think that's good to go back to 25mg and there is no rebound. Well done you for tuffin it out.

MD

Joe,

I think it is a wise choice about lowering your dose, for it may be harder for you to be compliant if these side effects continue (and they sound like they are). I did read somewhere that the side effects of the nal last longer for some, and I will try to dig it up (not saying it will be helpful, but reassuring).

I was not up to an AF day at 12 weeks (unless it was a nal over), so that is not a big deal for you are just not ready. My intake never decreased until later as well, so you are making wonderful progress.

Are you forcing your intake down or is it happening naturally (just curious)?

Not saying it makes a difference, for I had to force my intake down. I just wondered if it was happening naturally like some people say that the desire isn't there.

When I say I forced my intake down, I mean I forced. It felt like I was forcing an AF day (almost white knuckling), for I was still craving that drink but I didn't let it happen. But, that was easier than dealing with my nal overs. My nal overs were so bad that if I did drink a little over my allotment I would have anxiety/panic attack knowing I would wake up with one.

Again, your progress is very remarkable, and keep doing what you're doing for it is working for you.

Jaba

This is what I read:

When administered orally, naltrexone undergoes extensive biotransformation and is metabolized to 6β-naltrexol and other minor metabolites. Naltrexone has been recently approved by the Food and Drug Administration for the treatment of alcohol dependence. An important clinical issue with naltrexone treatment is predicting patient compliance, which may be influenced by adverse side effects experienced during the medication. We investigated whether subjective side effects were related to urinary concentrations of naltrexone and its metabolite 6β-naltrexol 3 hr after administration of 50 mg Po naltrexone in 24 male moderate-to-heavy social drinkers. The results showed significantly higher levels of urinary 6β-naltrexol (p < 0.05) in those subjects who experienced one or more side effect (i.e., headache, nausea, anxiety, or erection). Urinary naltrexone levels did not difter between the groups. Results also showed an approximate 10:1 ratio of 6β-naltrexol to naltrexone levels and a significant positive correlation between the parent compound and metabolite, suggesting parallel renal clearance. The results of this study suggest a possible mechanism for the side effects obsetved after acute administration of naltrexone.

http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract (hopefully the link works)

Jaba

Thanks, Jaba!

I think it was a little of both. Pre-TSM I was using a taper method to get from 12 unit/day to about 3, then I shot back up to 15 units (I'm assuming ADE here). I knocked that back down to 10 or so before and then started TSM the moment I got my hot little hands on the Nal. Nal made it easier to poke around and find the "indifference" to alch wherever it might show up. In my case, that was at the top end, so it made the tapering process easier. After some of that, I was able to set back the start time by taking the pill a bit later. Since I had to wait an hour, I'd get up to one or the other task, so the first beer might be an hour after the pill, or 90 minutes or even 2 hours because the Nal was lending some indifference there too. I'd get lost in the task and I'd simply forget to start an hour afterwards. So maybe a bit of grey-knuckling, but really not much.

Nalovers, that's a curious subject and I wish I knew more about the cause of that and why one person gets them so badly and the next doesn't. I started the Gabapentin at bedtime a bit over a week before I started TSM and it really helped me recover from the hangovers. I definitely felt better the next day. After I started the Nal, I felt more hungover again. It wasn't a huge thing, more like it just neutralized the gains from the Gabapentin in that respect. I still sleep better, so that benefit remains.

Well, aside from SE's, I really like the results so far and look forward to further improvements. Many thanks to my Nal-Pals here too, you all make it so much easier!

Wow! Great find, Jaba! That would seem to explain the mystery of the SE's rather neatly.

Joe,

I think I read a nal over is over drinking to where your receptors are causing withdrawal symptoms just like if your were taking an opioid and naltrexone. If I have a chance I will try to find that one as well.

It is funny for after I read that and thought about Barry's "method" it made sense, for your body and brain will put you through hell with that battle of receptors.

Trust me if you ever had one you would know.

I posted how it felt and what I went through when I first started posting here; it was similar to what Barry experiences and what others describe as opioid withdrawal.

A slight nal over isn't that bad, and some will think it is another hangover, but they are just slightly different. It is hard to describe, but it just doesn't feel like a normal hangover.

What I find so frustrating is those nal overs can happen regardless with the amount you drink, which doesn't make sense to me. So, my body, brain, and receptors are pushing me into withdrawal symptoms over a few glasses of wine? But, sometimes I can have 2-3 hard liquor drinks and have no side effects, not even a headache in the morning. Go figure! Which makes me think that there may be a little more to it. We may never know unless they do more research with people drinking on nal, or I may look into research of the pellet/injection for they have been doing research with people drinking on those (and have been for a while).

If you have a chance to speak to your TSM doctor about what I found and his thoughts on it. Hopefully if that is the case he can give you the okay to continue with a lesser dose, or prescribe a drug to help with the side effect.

I am a wimp when it comes to side effects, so you have my empathy.

Jaba

Yes, I hear a true Nalover is quite nasty!

I wonder if something in the wine makes them worse for you, as opposed to hard liquor. I've heard people say that they get less of a hangover from liquor, some say vodka is best in that respect. I've never been much of a guy for liquor and my interest in wine basically evaporated, but I some of that may be due to my drinking habit. I've tended to put off dinner, instead feeding my rumbling stomach with beer. Food just got in the way of my beer appetite. Earlier on I'd eat at the end of the night, but I noticed the hangovers were worse that way, so that got sacrificed to the Beer God too.

Wrt hangovers on naltrexone, pre-TSM I'd get hangovers that included the lack of balance, but not the cranial sensation that I notice with Nal (the sense that my skull and my brain are not moving in unison). Never had the "heaving deck" / feeling of being on a ship before the Nal though.

Others have mentioned the same thing about getting a Nalover from just a few drinks, really ripping ones too. I wonder if it's the sulfites in the wine that are worsening things for you, in a way that didn't happen pre-Nal. I've certainly gotten bad hangovers from having even one glass of wine after drinking beer most of the evening. If you could repro the results with hard liquor every time, it's gotta be something peculiar to the vino.

The pellet/injection route is going to avoid first-pass metabolism and 6-b-Naltrexol levels won't rise as quickly (Naltrexone and Naltrexol reach peak levels within an hour of an oral dose).

Here's an interesting approach:

https://www.drugabuse.gov/news-events/n ... technology

I have a question about the SE's in to my doc, but I'm afraid I have him scratching his head on this one. We'll see.

Joe - I have had Nal-overs on as few as 3 drinks and as many as 6 - and I drank Guinness so I do not think it has anything to do with what one drinks. My Nal-Overs were nowhere near as severe as Jaba's but they had me in bed for a day - I never had a hangover that did that to me. I think that if 25mg works for you, then just keep on that rather than try upping your dose again - if it works for you, it might not be optimal but it is better than your SE's which must be really disconcerting.

Glad that you are doing so well - you are definitely progressing.

Hugs, Maggie