A RISK-BENEFIT ASSESSMENT OF NALTREXONE IN THE TREATMENT OF ALCOHOL DEPENDENCE

There is a great deal of interest in the use of naltrexone as a treatm ent for alcohol (ethanol) dependence since there is a rapidly expandin g body of evidence to support its efficacy and tolerability in this in dication, Naltrexone, a long-acting, nonselective opioid receptor anta gonist has been shown to reduce alcohol intake when combined with beha vioural treatment, Naltrexone may prevent the return to clinically sig nificant drinking by blocking the pleasurable effects or 'high' associ ated with alcohol drinking. Results from controlled studies showed tha t in alcohol dependent patients taking naltrexone 50 mg/day in combina tion with behavioural treatment, relapse rates were reduced by 50% com pared with placebo treated patients. Historically, several factors hav e limited the use of effective pharmacological adjuncts In the treatme nt of alcohol dependence, These include safety considerations in this vulnerable population, and the fact that some treatment programmes dis courage alcohol-dependent patients from taking medications, The must c ommon adverse effects reported with the use of naltrexone at a dosage of 50 mg/day include nausea and vomiting, Naltrexone does not appear t o be hepatotoxic in dosages recommended in the treatment of alcohol de pendence, i.e. 50 mg/day. Thus, naltrexone appears to offer significan t therapeutic benefits at a relatively low risk, when used judiciously and with behavioural treatment for alcohol dependent patients.