What this episode covers

Naltrexone is one of the most practical and underused tools for alcohol use disorder. This episode focuses on when to use it, how to start it without overcomplicating things, and how to address the common concerns that tend to get in the way.

• When naltrexone makes sense (and when it doesn’t)
• How to start and dose it in real-world practice
• What to say about liver risk, side effects, and expectations

Quick Clinical Takeaways

• Frame naltrexone as having a dual effect: reducing both craving and the reward from drinking
• Don’t escalate beyond 50 mg daily—higher doses don’t meaningfully improve outcomes
• Start at 25 mg if tolerability is a concern, especially in patients sensitive to side effects
• Don’t let mild nausea or fatigue derail treatment—these are common early and usually self-limited
• Don’t avoid naltrexone for mild LFT elevations—the hepatic risk at standard doses is low
• Use it even if the goal is reduction, not abstinence—it works well in both scenarios
• Always confirm opioid-free status before starting—this is the one contraindication that changes management

Listen Now

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