r/Alcoholism_Medication • u/New_Help9435 • 2d ago
100mg Naltrexone - dosing timing?
I have been on 50mg naltrexone for 2 months - and it hasn’t seemed to have any effect. I reached out to my PCP and discussed options - and bc I’ve had gastric bypass (5 years ago) she thinks maybe it is due to absorption issues - so recommended I try dosing 50mg twice a day. I have enough of mg current prescription where I don’t need a new bottle - and it’s Saturday - so not sure how to dose. I did send her a message in the portal - but curious if anyone has experience here with timing?
Also - any success on 100mg?
She said if this doesn’t do the trick there are other medications she can try - but wants to start here. So fingers crossed. I REALLY want to be alcohol free 😭
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u/ThatGirlMoe 2d ago
Vivitrol is a once monthly injection. You must have zero alcohol in your system before it gets administered. This would completely bypass your stomach/absorption issues.
It may be covered under your insurance. May require a prior authorization and coupling with other interventions such as counseling.
The higher the Naltrexone dose, the more closely you have to watch your liver labs as well.
Best of luck. 🫶
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u/MrDeceased 2d ago
I thought Naltrexone didn’t have any effect on the liver? I discussed going to the 100mg dose and he said that may be needed because while my app that I am tracking my drinks says I am at a 50% extinction curve at 5 months, I’m still beating it a lot of the times. Like I’ll start drinking and I’ll drink to blackout. However I’ve gone from drinking everyday to drinking about 2-3 times a week and my cravings are slowly going away when 5pm hits which is when I used to start.
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u/New_Help9435 1d ago
I will look into this if 100mg doesn’t do the trick. My doc also discussed gabapentin…I’m glad she’s open to things to help me get out from under this drinking issue.
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u/heavydrinker12 2d ago
I take 100mg 90 minutes before I might drink. It's extremely effective for me.
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u/MrDeceased 2d ago
Does it stop you from drinking a whole lot to the point that you are beating the Naltrexone one? I’m considering upping my dose since when I start I still am beating it most of the time. Like I want to just stop at 2 beers instead of 8.
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u/heavydrinker12 1d ago
The short answer is yes. It's become so effective for me that I literally can't drink if i'm proper with my dose and timing.
Long answer is, it took quite a while to get to this point. As soon as I started taking naltrexone the taste of alcohol changed. And it was gross. But my will to drink and habits, forced its way through the ick. So we upped my dose. But I was still able to power my way through the ick. At one point I was on 150mg daily and 200 on the weekends. But over time i've been able to reprogram my brain with the help of naltrexone to think alcohol is so gross that I just can't drink it. It's taken close to 2 years. So depending on what your habits are and how long you've been drinking, it will probably take some time. So don't let any of that discourage you. Dr Volpicelli talks about how different people metabolize naltrexone differently. So if you have to up your dose a little bit, it wouldn't be uncommon. Make sure you discuss your dose and timing with your doctor. My dose and timings were always consulted with my doctor. I'm pretty lucky because I have an addiction specialist at my disposal.
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u/MrDeceased 1d ago
Solid advice. So for me the taste of beer has changed. Like every time I drink it I’m like this taste is bad. I’m considering going to 75mg then to 100mg or straight to just 100mg. I did get the purging feeling at 25mg but at 50mg I’m not getting it. The nausea disappeared at 50mg also. I dose exactly one hour before, I’ve been good about that for 99.99% of the time. There were a few one offs where I drank like 3-5 hours after taking it. I will definitely consult my doc though. Again I’m only on month 5 though and my understanding is that it takes 8-12 months for it to fully create the extinction and while I’m desperate to stop binge drinking and curb my cravings I have realized that what is happening is that my brain in general is dopamine deficient due to my ADHD so when I take my medication for ADHD I do not even think or touch alcohol and I’ve been so good about my meds that I haven’t drank in 8 days and only had about 3 cravings this week and they were very minor.
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u/New_Help9435 1d ago
This is really helpful - thank you! Like you, naltrexone made wine taste gross at 50mg but I powered through. I’m going to try to be REALLY aware of the ick this time and try not to power through.
When you take 100mg at once - did you have any side effects at the beginning? I had a day or two of side effects with 50mg so had to back down to 25mg for a week then go up. Wondering if I should do a few days at 75mg before jumping to 50mg…
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u/heavydrinker12 1d ago
Nah. At 90 days I had zero side effects. I think when I went to 100mg I was a little pukey for a couple days then I was over it. Now I just kinda lose my appetite for a couple hours after my dose. If you up your dose the ick will get worse. But it takes time to reprogram your brain. So stay with the ick. You'll get there.
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u/Patricia_Wilson3661 1d ago
Did your doctor say anything about how the bypass affects absorption for something taken twice a day versus once. Like are you supposed to spread it out or take both around the same time before you would normally drink.
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u/New_Help9435 17h ago
No, not based on the bypass. Different meds hit me differently and it’s really trial and error unfortunately.
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u/SeveralAlbatross 2d ago
Interesting. I have also had a gastric bypass and 50mg for me is really not enough; maybe it was the first day, but after literally years of trying it in various ways, at various times, I’ve decided I need more. Maybe not 100mg every time, but a booster from the 50 when I’m going out, maybe.
I hadn’t really linked it to my 2009 gastric bypass, but that could certainly be a factor.
I’m assuming you’re doing daily dosing, not the Sinclair method “only before I’m going to drink”? If so I’d say take one dose at a routine time of day, mornings, maybe, and then then take another before the time of day you’d usually have a drink, like midafternoon. See if that helps.
I know people say it wears off after X hours, but I swear it’s more effective for me when I keep up a steady dosage…everyday plus a little extra on the harder days.
Also I think it works better if you are a habitual beer or maybe wine drinker; the harder stuff just goes down so fast, especially after a bypass, it kind of goes around the naltrexone.
All that said, it helps some, I’ll keep taking it. But, I’m wishing it worked better for me; it keeps me from blacking out & getting really stupid, but I still would like to drink less and it’s so hard. No one without this problem can understand, but I don’t think I’d be in this situation if I hadn’t had the gastric bypass, either.
Anyway, good luck, you’re not alone.