FOAMcast - An Emergency Medicine Podcast · FOAMcast

Naltrexone for Alcohol Use Disorder

·17 min·1 clip

Oral naltrexone works within 60 minutes, while the monthly injection reaches a second peak two to three days later.

1. FOAMcast - An Emergency Medicine Podcast examines naltrexone for alcohol use disorder and its potential role in emergency departments. 2. Host Lauren Westifer explains emergency medicine treatment options and describes how clinicians can offer naltrexone during an ED visit. 3. Westifer’s central point is that naltrexone can reduce cravings and heavy drinking, even though it is not a guaranteed route to abstinence. 4. The episode defines alcohol use disorder using DSM-5 criteria: at least two symptoms within a 12-month period. 5. Westifer distinguishes mild disorder at two to three symptoms, moderate at four to five, and severe at six or more. 6. She explains that naltrexone blocks opioid receptors, which reduces the dopamine-related reward associated with drinking. 7. A systematic review and meta-analysis found 5.4 fewer drinking days versus placebo, while a 50-mg dose reduced heavy drinking days by 4.1 per month. 8. Oral naltrexone works in under 60 minutes and lasts about 24 hours; the 380-mg injection lasts about four weeks. 9. Westifer says clinicians should check for opioid use within seven days, pregnancy, acute liver failure, and transaminases above five times normal. 10. Emergency clinicians seeking practical alcohol-use-disorder treatment guidance.

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