Brief Answer:
Such severe side effects uncommon with Naltrexone

Detailed Answer:
Hello and welcome to Healthcare Magic. Thanks for your query.

I understand that you are going through a difficult time due to your problems. Naltrexone is an anti-craving medication which often causes some side effects in the first few days after starting the medication. Headache, fatigue / tiredness, muscle aches, nausea, etc. are frequently reported side effects. However, they are usually mild and self-resolving. They are rarely severe and disabling. But in your case, you seem to be experiencing prominent side effects even with half the dose, taken alternate days. So, I would suggest that you report these to your doctor, in order to check whether the medication needs to be stopped or changed.

The other possibility which needs to be ruled out is a possible drug interaction with the other medication that you are taking. For example, Naltrexone can interact with Cymbalta and very rarely cause liver problems. Therefore, my opinion is that it is best to let your doctor know about your symptoms, so that appropriate steps can be taken.


Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

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Brief Answer:
Latest findings of side effects of Naltrexone...

Detailed Answer:
Hello again,

It's good that your prescribing doctor has ensured that your liver function tests are normal. Now, one important thing to remember is that the extent and severity of side effects vary widely from person to person. For the same dose of medication, some persons may not experience any side effects while some may experience severe side effects. This does not mean that if you are having severe side effects, then you have an anomaly. Each person's drug metabolism and drug tolerability is different.

According to the latest research evidence from several studies, 10 - 15 % of persons prescribed a 50mg / day of oral Naltrexone experience side effects. Most of them experience only mild side effects and are able to continue the medication.

According to one large recent study, the following are the percentages of the different types of side effects on taking low-dose Naltrexone:
Anxiety 15.7
Nausea 12.4
Abdominal discomfort 11.6
Drowsiness 11.6
Headache 11.6
Dizziness 10.7
Insomnia 8.3
Muscle pain 8.3
Loss of appetite 8.3
Vivid dreams 5.0
Mood change 3.3
Trouble concentrating 1.7

Also, a recent study published in the Journal of the XXXXXXX Medical Association, comparing different anticraving agents for the treatment of alcohol dependence - namely Naltrexone, Acamprosate and Topiramate - showed that the percentage of persons discontinuing treatment because of adverse effects was relatively higher with Naltrexone when compared with Acamprosate and Topiramate.

According to the latest prescribing guidelines, doctors are advised to stop the medication if the patient is experiencing severe and untolerable side effects. Further medical / lab tests should be done to evaluate the reason for such severe side effects.

Patients are advised to report to their doctor immediately if they have any of the following severe symptoms:
- Extreme tiredness or fatigue
- Unusual bleeding or bruising
- Severe abdominal pain or chest pain
- Persistent vomiting or diarrhoea
- Yellowinsh colouration of urine
- Blurring of vision
- Confusion or visual hallucinations
- Excessive dizziness
- Any allergic reaction (including skin rashes or wheezing / shortness of breath)

In my own clinical experience, I have seen that 1 in 5 persons complain of some mild side effects. However, rarely if someone complains of severe side effects that are disabling, then I stop the medication.

Since you have mentioned that your side effects are quite severe and disabling, I would deem it necessary to inform your prescribing doctor as early as possible.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

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