Separating Myth from Fact: Naltrexone effective time and re-dosing

Recently, there has been a lot of confusion about the effective time period for a standard dose of naltrexone and we want to set the record straight. We’ve noticed an increased amount of misinformation that is not based on the existing body of research or knowledge of this medication. Further clouding the situation, C Three Foundation CEO Claudia Christian accidentally misspoke in an video interview and her words led some to improperly believe (and then assert as fact) that naltrexone is completely flushed from the system after six hours. (It’s not.)

Below is Claudia’s statement, mildly edited for format, structure, and punctuation.

Statement from Claudia Christian:

I’m sorry for any confusion about dosing. I have had many discussions with doctors over the years. Some have stated that a patient has to take a dose of naltrexone every 4 hours, and some have said 8 hours is fine. Dr. Sinclair told me personally that I would be “safe” for 10 hours after taking a 50mg dose. My own doctor advises people to re-dose “as per needed.”

Clearly this has led to some confusion, including my own personal confusion. It’s difficult when you Google it and this comes up for example for the brand Revia:

“REVIA is a pure opioid receptor antagonist. Although well absorbed orally, naltrexone is subject to significant first pass metabolism with oral bio-availability estimates ranging from 5 to 40%. The activity of naltrexone is believed to be due to both parent and the 6­ ß-naltrexol metabolite. Both parent drug and metabolites are excreted primarily by the kidney (53% to 79% of the dose), however, urinary excretion of unchanged naltrexone accounts for less than 2% of an oral dose and fecal excretion is a minor elimination pathway. The mean elimination half-life (T-1/2) values for naltrexone and 6-ß-naltrexol are 4 hours and 13 hours, respectively. Naltrexone and 6-ß-naltrexol are dose proportional in terms of AUC and Cmax over the range of 50 to 200 mg and do not accumulate after 100 mg daily doses.”

Okay…what the heck does that mean in real life terms?

I have noticed that by taking the middle ground and suggesting people talk to their doctor about taking a second dose 6 hours after the first dose, they seem to respond well. Does that mean that the first dose of naltrexone could have protected them for another hour or two or three? I have no idea.

Everyone’s metabolism is different and (their weight, etc.) Certain factors can influence how long naltrexone stays in the system. One is age. Older people tend to take longer to eliminate drugs from their system compared to younger people. A patient’s overall health and any chronic illnesses can also influence how long naltrexone stays in the system. People with a faster metabolism will eliminate naltrexone more quickly than someone with a slower metabolism. Other individual factors that influence how long naltrexone stays in the system can include body mass and hydration level. The average eliminate half-life of naltrexone is between 4 hours and 13 hours.

All of that said and debated comes down to this: What works for you? When you take one dose and have a few drinks? When you take a dose every 8 hours if you’re going to have a weekend that involves both lunch and dinner imbibing? I can’t tell you that.

Your doctor can advise you on what they feel is “right” but at the end of the day it comes down to you to figure out how you metabolize naltrexone, when you “feel” it is out of your system, and when you feel vulnerable to heavy drinking experiences.

I hope this helps clarify the dosage questions and allows you the freedom to customize your own recovery with your doctor’s support. If you feel that a second dose is helping you then you must speak to your doctor to ensure that you have an adequate supply of medication.

Best,

Claudia

24 Comments

  1. Roberta on November 13, 2018 at 8:17 pm

    Dear Claudia,
    You and I have put me on the path of naltrexone.
    Dosing , brand , freqiuency , and expectations are all ambiguous… I am 8 month in…have changed brands from Noctict..( apparent 1 1/2 hour wait)… absolute compliance…to Naltima ( 1 hour wait)…absolute compliance…no effect… or difference…except nodict makes me feel very sick 🤕….and naltima has had no effect…
    I can say my drinking levels have reduced from 10 / day ..to 6/ day….nothing past that..👎😡👩‍💻😡🤔
    I remember the chalk board “ DONT GIVE UP”…
    But…darn it ,,,this disclosure statement has me 😧….worried



    • C Three Foundation on November 16, 2018 at 9:49 am

      I understand that you feel frustrated, but your post says you have reduced your alcohol intake by 40%. That’s actually a great thing!

      We wrote a blog with additional tips for addressing things like habit drinking: https://cthreefoundation.org/tsm-hacking-alcohol-recovery

      And I encourage you to review this guide we made that is based off a survey of actual TSM users and their reduction times: https://cthreefoundation.org/drink-reduction-over-time-using-the-sinclair-method



      • Roberta on January 3, 2019 at 12:34 pm

        Dear Claudia,
        I’m now 9 months in. Still no reduction. I have increased my dose to 75 mg. I will see if that helps.
        🤦‍♀️



  2. Lois Kuiper on November 16, 2018 at 6:47 pm

    I have had gastric bypass.. 14 years out. Lost and kept off over 100 pounds. Started having seizures, 5 in part 6 yes. Taking Keppra for that. Concerned with mal absorption due to bypass. Drink about a bottle of wine nearly daily. 67 years old.



    • John Moody on October 3, 2019 at 4:06 pm

      I also have a past with a similar bariatric surgery. I think that’s why i got to drinking like I did (up to about 100+beers in a week) I substituted the beer for the food that I no longer had room for, but had plenty of room for beer. I has gotten out of hand. Hopefully TSM will help me.



      • John on December 2, 2019 at 11:35 am

        Can persons with bariatric surgery, crush a naltrexone tablet, and take 1/4 of the dust every 15 minutes, or 1/2 the dust every 15 minutes, or whatever works for you, and allow the dust to dissolve in the mouth, maybe under the tongue, before swallowing? In this way, a higher amount of the medicine might be absorbed into the body, than if a tablet was swallowed whole.



      • C Three Foundation on December 3, 2019 at 2:22 pm

        It is not advisable for people to crush medication. Additionally, medications that are not specifically formulated for use dissolved under the tongue aren’t better absorbed by taking them in a manner they were not designed to be taken.

        For issues of poor absorption, please take your prescription to a compounding pharmacist and they can professionally re-formulate your medication into a form that can be crushed, chewed, dissolved, etc.



    • John on December 2, 2019 at 12:07 pm

      Naltrexone is available as an injection, 360 mg , given once a month, or a tablet could be broken in half, and each half chewed and allowed to dissolve in the mouth and slowly swallowed, 15 minutes apart, or whatever works for you. Hope this helps.



      • C Three Foundation on December 3, 2019 at 2:26 pm

        Yes, naltrexone is available in other forms, but those forms do NOT work with the Sinclair Method. The reason is that TSM is, by definition, TARGETED. The injection is time released and forms a blockade on your endorphin system 24/7…so you are constantly dampening your reward system.

        Also, unless a person has taken their prescription to a compounding pharmacy and specifically had their nal reformulated to allow it to be chewed or dissolved, this is very bad advice and it can increase side effects.



    • Dana Diaz on December 4, 2019 at 11:36 pm

      I ordered Nordict from India and took a 50mg tablet for alchohol issues. I became extremely dizzy, nauseous, couldn’t eat and felt like I had been poisoned for about 15 hours. I had to miss work and would have welcomed a hangover to this feeling! I literally stayed in bed for a day and a half! I was really hopeful after research and watching the documentary! Any advice or input on my reaction to the meds?



      • C Three Foundation on December 13, 2019 at 4:21 pm

        Dana,

        I’m sorry to hear that you had such a bad reaction. We highly recommend that people get their prescription from a licensed medical provider and purchase their medication from a local pharmacy. This ensures that the medication is not counterfeit, nor altered in any way since it is controlled through a formal regulatory process. Additionally, any side effects should be reported to your prescribing medical doctor. In the event of feeling “poisoned” or harsh side effects, you should follow whatever the emergency medical protocol is for your country (in the US, that would be to call poison control or 911) and seek emergency medical treatment.



  3. Christy on September 1, 2019 at 8:04 pm

    Claudia can you please answer a quick question for me? I am on day two of taking half of the prescription for Naltrexone, as was directed. I have already noticed a significant change in my desire for eating. I am currently 202 pounds so this is definitely an ok thing at this point! I am just wondering how “normal” this is and what I might be able to expect in the future. Does that taper off as time goes? What is normal? When is there a a reason for concern? With only being at 1/2 dose and feeling this way it makes me wonder. Thank you ever so much! This pill has saved my life.



    • C Three Foundation on September 5, 2019 at 2:23 pm

      Christy,

      Neither Claudia nor myself are doctors, so we cannot give any medial advice. When it comes to side effects, each person is different. The best thing to do is figure out if the side effects are bothersome, or if they last longer than the first 10-14 days (the typical amount of time when most people see side effects fade if they get any at all). At that point, please talk to your doctor. Naltrexone is used in conjunction with Wellbutrin in an FDA-approved weight loss drug, so it’s not really out of the ordinary. Also, as you drink less alcohol, you may find yourself taking in fewer empty calories from the alcohol, which can also assist some people in losing weight.



  4. Shawneen on October 20, 2019 at 8:57 pm

    I willingly chose this medication instead of suboxone i made sure i was 8 days into with draw from opioids but it may be a bad choice for me as i have a sharpe pain in my gut about 45 minutes into taking the oral 50 mg dose anyone have a clue if this is normal



    • C Three Foundation on November 5, 2019 at 5:30 pm

      The Sinclair Method is strictly for use with alcohol use disorder. If you are attempting to use TSM with opiates, or within 10-14 days of taking opiates, you can have severe and dangerous interactions. Naltrexone and opiates should never be mixed because it can cause a precipitated withdrawal, which is much worse than a typical withdrawal.



  5. Alan Faber on November 14, 2019 at 1:04 pm

    I have started taking 50 mg Naltrexone per the TSM.
    One thing I haven’t seen mentioned is what is the minimum a person should drink in order for the pharmacological extinction to occur. Is one drink enough or would I need to drink 2 or more? I know that if you don’t drink any alcohol after taking the Naltrexone, the TSM doesn’t work, so what would be the minimum alcohol intake (I am a 185 pound male, if that matters).

    Thanks,
    Alan



    • C Three Foundation on November 15, 2019 at 9:37 am

      Alan,

      If you’re looking for the “minimum” amount of alcohol, drink N/A beer. It has traces of alcohol, but it’s also going to provide the same “alcohol cues” as a regular beer. Your reward system activates on both the alcohol itself, but also the anticipation, the taste and smell, the sound of the bottle or can opening, the feel of it in your hand, etc. All of these things combine to make your drinking experience rewarding…and so if you use TSM with an N/A beer, you’re still having extinction sessions, but with only a fraction of the alcohol.



      • Alan Faber on November 15, 2019 at 11:51 am

        Thanks for your reply. I have read that it can take 2-3 months for the full extinction to take in some persons. If I am not in the mood to drink on a particular day, is it suggested that I have a drink anyway to speed the process along? I am assuming the answer is no.
        Also, should I take Naltrexone on a day when I drink N/A beer, but not regular alcoholic beverages?



      • C Three Foundation on November 18, 2019 at 1:37 pm

        If you do not feel like drinking…don’t. The TSM protocol calls for naltrexone one hour prior to the first alcohol-containing drink of the day. N/A beers have small amounts of alcohol in them…enough that someone underage is not permitted to buy, possess, or drink them.



  6. Alan Faber on November 22, 2019 at 11:20 am

    N/A beers have up to 0.5% of alcohol in them.
    When I am in the mood for a beer (yes, I actually do enjoy the taste), I drink an N/A beer.
    Should I take Naltrexone if I am only having N/A beer no other alcoholic beverages?



    • C Three Foundation on November 22, 2019 at 11:54 am

      As I mentioned before, “The TSM protocol calls for naltrexone one hour prior to the first alcohol-containing drink of the day.” That means if you are drinking something with alcohol…including N/A beers that do have alcohol, then you would want to continue following the protocol every time.



  7. Erica on January 13, 2020 at 12:28 am

    It took a full year of 100% compliance (50 mg oral Naltrexone) for TSM to work for me. For the first 6 months, my desire didn’t diminish at all, but I was determined and I stuck with TSM. Its now been 2 years. Sometimes I still imbibe, maybe 4 cocktails over the course of an evening-but that is rare (maybe 3-4 times last year). It works but it requires determination and patience. Take the pill. Set a timer. Wait 60 min. Have a drink. It’s ok. Trust the method. Give it time. If you don’t feel a diminish is your craving or urge to drink yet—be patient. It took me 2 years. I am grateful TSM. I am grateful for the courage of others to share their stories. Stick with it. You have nothing to lose and everything to gain. Good luck.



  8. Adam on February 7, 2020 at 7:03 am

    HI,

    After years of drinking too much and it worsening my already bad anxiety (which im on Sertraline and Pregabalin for) I decided to do something and started taking Disulphiram (Antabuse) to stop me drinking. I didn’t have a drink for 3 months and tehy were the best 3 months of my life that I can remember! However, I wanted to see if there was a middle ground and so I’m now using Disulfiram Monday to Friday and then using Naltrexone to drink on a Saturday and Sunday.

    The naltrexone was started purely off the back of One Little Pill and after I watched the guy with the bottle of Jagermeister, I expected a lot (a miracle maybe) and so far, haven’t had it and feel disillusioned. I have only been on it for 2 months now and reading the posts above it makes me realise that I need to be patient. However, I’m 6’2″ and 270lbs. Is it possible that 50mg just isn’t enough for me and are there any risks from me taking 100mg before drinking instead?



    • C Three Foundation on March 5, 2020 at 4:26 pm

      Adam,

      Medical advice is best discussed with a doctor who can take your medical history into account. Since TSM doesn’t use Antibuse, we really don’t know what switching back and forth may do or what risks that might present. The one thing that we can say for certain is that if you are forcing yourself to abstain and have alcohol free days, you are at risk for triggering the alcohol deprivation effect. Forced alcohol free days where you are white knuckling through cravings are not the same as recognizing and working through a temporary trigger and seeing your craving disappear…resulting in an alcohol free day. So it may not be the dose that is the issue, but the way you are only doing TSM 2 days a week, which would be a 2 month equivalent of barely over 2 weeks.) Generally speaking, you should either do TSM or not do TSM. Switching back and forth will prolong your process and possibly confuse your brain.

      Imagine if you wanted to learn to speak a new language. You wouldn’t expect it to be easier if you practiced that language 2 days a week, but a completely different language on the other 5 days. Same here.