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Bad Side Effects of Naltrexone

By Carole Anne Tomlinson ; Updated August 14, 2017

Side Effects, Contraindications, and Cautions

An attractive feature of naltrexone for treating patients who are alcohol dependent is that, like disulfiram and acamprosate, the medication has virtually no abuse potential and patients do not develop tolerance for its efficacy. Side effects are generally mild and often diminish over time (Exhibit 4-2), although less common reactions and some potentially serious reactions have been reported (Exhibit 4-3). Nausea is one of the most frequently reported side effects. One study (O'Malley, Krishnan-Sarin, Farren, & O'Connor, 2000) suggests that women may be particularly susceptible to this side effect, which the authors argue supports the use of risk-minimizing strategies, such as gradual dosing starting with a lower dose, requiring abstinence for a specific amount of time before starting naltrexone, and providing support and supervision to help patients cope with nausea until it subsides. However, in clinical studies side effects were rarely cited by patients as reasons for discontinuing treatment with naltrexone. Exhibit 4-2 Oral Naltrexone Side Effects Most Common Less Common Nausea Vomiting Headache Dizziness Fatigue Nervousness Anxiety Somnolence Diarrhea, constipation, stomach pains, cramps Chest pain, joint/muscle pain Rash Difficulty sleeping Excessive thirst, loss of appetite Sweating Increased tears Mild depression Delayed ejaculation Exhibit 4-3 Naltrexone Contraindications Patient Condition or Circumstance Treatment Recommendation Current illicit opioid use (as indicated by self-report or a positive urine screen) or buprenorphine (Suboxone® or Subutex®) or methadone maintenance therapy for the treatment of opioid dependence; currently undergoing opioid withdrawal Do not prescribe oral naltrexone; consider an alternative medication Acute hepatitis or liver failure Do not prescribe oral naltrexone Anticipated need for opioid analgesics within the next 7 days Do not prescribe oral naltrexone History of sensitivity to naltrexone, to structurally similar compounds (e.g., naloxone or nalmefene), or to any inactive ingredients in the tablet

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