Efficacy and Tolerability of Naltrexone in the Treatment of Alcohol Dependence: Oral versus Injectable Delivery

Roozen, Hendrik G.; Waart, Ranne de; Brink, Wim van den

doi:10.1159/000104882

Cited by 14 publications

(10 citation statements)

References 51 publications

(57 reference statements)

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“…Side-effects are similar to those of the oral preparation and include nausea; however, injection site pain and reactions have been reported, possibly related to poor injection technique, and some required medical treatment (Garbutt, 2009). Unfortunately, no direct comparison between immediate-release oral naltrexone and extended-release injectable naltrexone is available, and it is not possible to make an evidencebased benefit-risk assessment (Roozen et al, 2007).…”

Section: (Ib)mentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short-and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people. KeywordsSubstance misuse, addiction, guidelines, pharmacotherapy, comorbidity 1 Imperial College London, CNWL NHS Foundation Trust, London, UK 2 Gether NHS Foundation Trust, Gloucester, UK 3 Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UKOther invited participants at the consensus meeting who contributed to the discussion and commented on the guidelines were Drummond C, Farrell M, Gilvarry E, Strang J. John, a user representative, read and commented on the written guidelines. Prof W van den Brink reviewed the written guidelines.

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Section: (Ib)mentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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“…Side effects generally correspond to peak dose effect. One solution to this less than optimal profile was the development of injectable extended release naltrexone, which provides therapeutic levels for 30 days after a single injection [37]. King and colleagues [38] suggest that individuals who show greater naltrexone biotransformation, thus higher levels of urinary 6--naltrexol experience more side effects.…”

Section: Pharmacokinetics and Safetymentioning

confidence: 99%

Naltrexone for the Treatment of Alcoholism: Clinical Findings, Mechanisms of Action, and Pharmacogenetics

Ray

Chin²,

Miotto³

2010

CNSNDDT

103

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Naltrexone is an opioid receptor antagonist with established efficacy, albeit moderate, for the treatment of alcohol dependence. This manuscript provides a critical review of the literature on naltrexone as a pharmacotherapy for alcoholism by covering the following areas: (a) clinical findings from treatment studies; (b) pharmacokinetics and safety data; (c) medication compliance and persistence; and (d) neurobiological and biobehavioral mechanisms of action of naltrexone for the indication of alcohol dependence. This review will then focus on the emerging literature on naltrexone pharmacogenetics, which has the potential to identify responders on the basis of genetic variation and to use genetic tools to individualize the use of this medication. Limitations and future directions in the research and practice of naltrexone for alcoholism are also outlined.

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“…As previously mentioned, naltrexone is a prescription medication that has been approved by the U.S. Food and Drug Administration and promoted for use in AUD populations (Garbutt et al., ; Hernandez‐Avila et al., ; Roozen et al., ). Naltrexone acts to decrease alcohol cravings and reduce the reinforcing effects of alcohol consumption by blocking opioid‐mediated increases in central dopamine release (Gianoulakis, ).…”

mentioning

confidence: 99%

“…Naltrexone acts to decrease alcohol cravings and reduce the reinforcing effects of alcohol consumption by blocking opioid‐mediated increases in central dopamine release (Gianoulakis, ). Administration options include oral medication once per day or a once‐a‐month injectable (Garbutt et al., ; Hernandez‐Avila et al., ; Roozen et al., ). While the optimal dose of naltrexone is not known, most studies used 50 mg/d (range 50 to 150 mg).…”

mentioning

confidence: 99%

A Systematic Review of Naltrexone for Attenuating Alcohol Consumption in Women with Alcohol Use Disorders

Canidate

Carnaby

Cook

et al. 2017

Alcohol Clin Exp Res

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Several clinical trials have evaluated naltrexone as a treatment for alcohol use disorders, but few have focused on women. The aim of this review was to systematically review and summarize the evidence regarding the impact of naltrexone compared to placebo for attenuating alcohol consumption in women with an alcohol use disorder (AUD). A systematic review was conducted using PubMed, Cochrane, Web of Science, CINAHL, and Alcohol Studies Database to identify relevant peer-reviewed randomized controlled trials (RCTs) published between January 1990 and August 2016. Seven published trials have evaluated the impact of naltrexone on drinking outcomes in women distinct from men. 903 alcohol-dependent or heavy drinking women were randomized to receive once daily oral or depot (injectable) naltrexone or placebo with/without behavioral intervention. Two studies examining the quantity of drinks per day observed trends toward reduction in drinking quantity among women who received naltrexone vs. placebo. The 4 studies examining the frequency of drinking had mixed results, with one study showing a trend that favored naltrexone, two showing a trend that favored placebo, and one that showed no difference. Two of the three studies examining time to relapse observed trends that tended to favor naltrexone for time to any drinking and time to heavy drinking among women who received naltrexone vs. placebo. While the growing body of evidence suggests a variety of approaches to treat alcohol use disorders (AUD), the impact of naltrexone to combat AUD in women is understudied. Taken together, the results suggest that naltrexone may lead to modest reductions in quantity of drinking and time to relapse, but not on the frequency of drinking in women. Future research should incorporate sophisticated study designs that examine gender differences and treatment effectiveness among those diagnosed with an AUD and present data separately for men and women.

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Efficacy and Tolerability of Naltrexone in the Treatment of Alcohol Dependence: Oral versus Injectable Delivery

Cited by 14 publications

References 51 publications

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Naltrexone for the Treatment of Alcoholism: Clinical Findings, Mechanisms of Action, and Pharmacogenetics

A Systematic Review of Naltrexone for Attenuating Alcohol Consumption in Women with Alcohol Use Disorders

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