Based on TIP 28

Naltrexone and Alcoholism

Treatment 

KAP Keys

For Clinicians

CSAT’s

Knowledge Application Program

KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

These KAP Keys were developed to accompany the Treatment

Improvement Protocol (TIP) Series published by the Center for

Substance Abuse Treatment (CSAT), Substance Abuse and

Mental Health Services Administration. These KAP Keys are

based entirely on TIP 28 and are designed to meet the needs

of the busy clinician for concise, easily accessed "how-to" information.

For more information on the topics in these KAP Keys, readers

are referred to TIP 28.

Introduction

TIP 8, Intensive Outpatient Treatment for Alcohol and Other

Drug Abuse (1994) BKD139

TIP 11, Simple Screening Instruments for Outreach of Alcohol

and Other Drug Abuse and Infectious Diseases (1994)

BKD143

TIP 14, Developing State Outcomes Monitoring Systems for

Alcohol and Other Drug Abuse Treatment (1995) BKD162

TIP 20, Matching Treatment to Patient Needs in Opioid

Substitution Therapy (1995) BKD168

TIP 27, Comprehensive Case Management for Substance

Abuse Treatment (1998) BKD251

Other Treatment Improvement Protocols (TIPs)

that are relevant to these KAP Keys:
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

• Naltrexone is an appropriate part of treatment for alcoholdependent patients, including binge drinkers.

• The only absolute contraindications are liver failure, acute

infectious hepatitis, and current dependence on opioids or

active opioid withdrawal. Elevated bilirubin levels, pregnancy,

breast feeding, severe obesity, and use in adolescents are

relative contraindications.

• At the currently recommended dose of 50 mg daily, hepatic

toxicity is very unlikely. Continued alcohol use is more likely

than naltrexone to cause liver damage.

• Providers should perform Liver Function Tests prior to treatment initiation and periodically during treatment.

• Abstinence will be a desired goal for alcohol-dependent

patients; however, reductions in drinking may be an acceptable intermediate outcome. Failure to maintain complete

abstinence is not necessarily a failure of treatment because

there are many other areas of a patient's life that can

improve, such as job performance, social relationships, and

general physical health. This is similar to the goal of reducing

high blood pressure; not all patients will have a total

improvement of hypertension.

• Naltrexone is likely to be most effective when used in combination with other forms of treatment for alcoholism, such as

psychosocial interventions, and when patients comply with

both.

Information on Naltrexone for

Primary Health Care Providers

1
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

Naltrexone, when combined with appropriate psychosocial therapies for alcohol-dependent or alcohol-abusing patients, can

reduce 

• The percentage of days spent drinking

• Relapse to excessive and destructive drinking

• The amount of alcohol consumed on a drinking occasion 

Research has also shown that

• At the recommended dose of 50 mg/day, hepatic toxicity due

to naltrexone is very unlikely

• Continued alcohol use is more likely than naltrexone to

cause liver damage

Research Findings 2
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

Eligibility for Treatment 3

Those eligible for treatment include

• Individuals who have been diagnosed as alcohol dependent,

are medically stable, and are not currently (or recently) using

opioids

• Individuals with an interest and willingness to take naltrexone

• Individuals who are willing to be in a supportive relationship

with a health care provider or support group to enhance

treatment compliance and work toward a common goal of

sobriety

Individuals who are not suitable candidates include

• Those with acute hepatitis or liver failure

• Patients requiring narcotic analgesia

• Pregnant or nursing women

• Possibly the very obese

Based on an analysis of risk versus benefit, clinician and

patient may choose to start naltrexone treatment in spite of

the presence of medical problems because the possible benefits of reducing or eliminating alcohol consumption may outweigh the potential risk of naltrexone. However, the final decision to use naltrexone should be based on the provider's

clinical judgment and the patient's right to choose treatment deemed appropriate.
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

Safety Identification Card 4

To Medical Personnel Treating Me in an

Emergency:

This patient is taking the oral opioid antagonist reVia, formerly known as Trexan (naltrexone hydrochloride). 

In an emergency situation in patients receiving fully blocked

doses of reVia, a suggested plan of management is regional

anesthesia, conscious sedation with benzodiazapine, use of

non-opioid analgesics, or general anesthesia.

In a situation requiring opioid analgesia, the amount of opioid

required may be greater than usual, and the resulting respiratory depression may be deeper and more prolonged.

A rapidly acting opioid analgesic that minimizes the curation of

respiratory depression is preferred. The amount of analgesia

administered should be titrated to the needs of the patient.

Non-receptor mediated actions may occur and should be

expected (e.g. facial swelling, itching, generalized erythemia, or

bronchoconstriction), presumably due to histamine release. 

Irrespective of the drug chosen to reVia (naltrexone hydrochloride) blockade, the patient should be monitored closely by

appropriately trained personnel in a setting equipped and

staffed for cardiopulmonary resuscitation.

For medical emergencies, call your regional Poison Control

Center

Further information may be obtained by calling: 

1-800-4PHARMA

The name and telephone number of physician who prescribed reVia (naltrexone hydrochloride)

Physician's name: 

Physician's telephone: 

Patient's name: 

Patient's telephone: 

Date treatment was initiated: 
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

Alcohol Urge Questionnaire 5

Listed below are questions that ask about your feelings about

drinking. The words "drinking" and "have a drink" refer to having

a drink containing alcohol, such as beer, wine or liquor. Please

indicate how much you agree or disagree with each of the following statement by placing a single mark (like this: X) along each

line between STRONGLY DISAGREE and STRONGLY AGREE. The

closer you place your mark to one end or the other indicates the

strength of your disagreement or agreement. Please complete

every item. We are interested in how you are thinking or feeling

right now as you are filling out the questionnaire.

RIGHT NOW

1. All I want to do is have a drink.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

2. I do not need to have a drink right now.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

3. It would be difficult to turn down a drink this minute.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

4. Having a drink right now would make things seem just perfect.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

5. I want a drink so bad I can almost taste it.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

6. Nothing would be better than having a drink right now.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

7. If I had the chance to have a drink, I don't think I would drink it.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

8. I crave a drink right now.

Strongly Disagree Strongly Agree

____:____:____:____:____:____:____

Reprinted with permission from Michael J. Bohn.
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

Management of Common Adverse

Effects of Naltrexone 

6

Common adverse effects, which may include nausea,

headaches, dizziness, fatigue, nervousness, insomnia, vomiting, and anxiety, occur in approximately 10 percent of patients.

Some recommendations for dealing with adverse effects are

• Patient education: If patients are going to experience common adverse effects, these tend to occur early in treatment,

and the symptoms generally resolve within 1 to 2 weeks.

Support can help patients better tolerate the effects.

• Timing of doses: Morning doses should be suggested for

most patients to establish a routine and ensure better compliance.

• Split dosage: If there is a need to split the dose, then the

patient should take half in the morning and half in the

evening, preferably with dinner.

• Management of nausea: To manage nausea, patients

should take naltrexone with complex carbohydrates (such as

bagels or toast) and not take the medication on an empty

stomach. 
KAP KEYS Based on TIP 28

Naltrexone and Alcoholism Treatment

Naltrexone and Other Substances

The use of other substances during naltrexone during treatment,

particularly illegal opiates and opioid-containing medications,

may pose the same level of concern and possible adverse consequences as the use of alcohol. Random urinalysis, collateral

reports from family members or employers (with the patient's

written permission), and self-reports from the patient can be

used to evaluate the use of other substances. In addition to illegal substances, the use of both prescription and nonprescription

medications should also be addressed. The patient's agreement

or resistance to continuing treatment may indicate his or her level

of willingness to consider other substance use as a problem.

Other things to consider

• Patients should be warned that self-administration of high

doses of opiates while on naltrexone is extremely dangerous

and can lead to death from opioid intoxication by causing respiratory arrest, coma, or circulatory collapse.

• Physicians should be aware of all of the patient's medications

and watch closely for naltrexone's interaction with other drugs.

• Both patient and provider should know that naltrexone does

not make people "sober up" and does not alter alcohol's acute

effects on cognitive functioning.

7
Easy Ways to Obtain Free Copies 

of All TIP Products

1. Call SAMHSA’s National Clearinghouse for Alcohol and

Drug Information (NCADI) at 800-729-6686, 

TDD (hearing impaired) 800-487-4889.

2. Visit CSAT’s Website at www.csat.samhsa.gov

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of

Communications, Substance Abuse and Mental Health

Services Administration, U.S. Department of Health and

Human Services.

Ordering Information

TIP 28

Naltrexone and Alcoholism Treatment 

DHHS Publication No. (SMA) 01-3590

Printed 2001