selincro/nalmefene and alcohol

Ok, so only made it to day 2. It felt weird not having a bottle in the evening so went out for a bottle which I drank but really didn't enjoy so didn't go out for more like I normally would. Will persevere . Hope I get more sleep tonight and will try again tomorrow.

Jan

Ok, so only made it to day 2. It felt weird not having a bottle in the evening so went out for a bottle which I drank but really didn't enjoy so didn't go out for more like I normally would. Will persevere . Hope I get more sleep tonight and will try again tomorrow.

Jan

Ok, so only made it to day 2. It felt weird not having a bottle in the evening so went out for a bottle which I drank but really didn't enjoy so didn't go out for more like I normally would. Will persevere . Hope I get more sleep tonight and will try again tomorrow.

Jan

Day 2 is a big improvement. Let's go for day 3... 

My my son is a alcoholic half his life in and out of jail beaten by police Even worse. He's only 38 and in the 3rd stage of kidney failure. I luv who he was before drinking and miss him so much.

HOPE4CURE

Good point. There needs to be more education on the drugs used for alcohol detox. 

Day 5. Went out for a meal yesterday and had 1 white wine spritzer, didn't want any more after that. No alcohol today, I definitely think things are improving. Still having the odd craving for wine but it doesn't last long, I tell myself that if I really want a drink after half an hour then I'll go out and buy some - so far so good.

Interested to see this advice. It seems to me not clear how long you should take it continuously in order for the effect to really take hold, i.e. to break the association between booze and the expectation of pleasure.

Getting over the side effects is a separate (also important) thing. I was getting a lot of insomnia at first, it's worn off quite a bit but not completely. But it's not like insomnia that I've had before, in that it's more calm and so easier to deal with and maybe not as exhausting.

Going back to your point: I'm afraid that if I went straight to taking it only when I was expecting to drink, I'm not ready for that and I'd just not take it. Especially as (for me at least) it takes longer to kick in than the "one or two hours" they mention in the instructions. I find 3 or 4 hours is more like it.

Anybody else any thoughts on any of this? Seems to be very little user experience on the web so far - not surprisingly of course.

I think you are right and the drug information from the manufacturer seems limited. Like the time it takes to kick in, how to get the body accustomed to it before going out and having a night out ruined because of side-effects before you have become accustomed to it. I would have expected a drug that you take daily and which has the effect for 24 hours (which is therefore repeated daily IN CASE you have a drink) would be more suitable than taking a drug ONLY when you plan to drink.

Maybe they will develop a slow release one at some point.

Absolutely! On the basis that the drug is active in the system for 24 hours and, presuming that the effect of same diminishes over that 24 hours I have elected to try 1 week of taking the drug daily in the morning and I'm hoping that a) I wont suffer insomnia and, b) that the drug will still be active enough in the evening to stop my desire to drink. Will let you know!

That's sounds like a good idea I might try it too. What affect does it have with driving if I take in the morning before work though? Happy new year! 

Not sure on the driving front I'm afraid! I'm lucky enough to be able to walk to Work. HNY!

There is no suggestion that you should not drive after taking Nalmefene. However, you shouldn't drive when you are feeling ill, so if you suffer any serious side effects such as dizziness or nausea, you should avoid driving while that is the case.

Thanks Paul do you recommend I take it everyday for a week regardless of drinking or not to get accustomed to side affects?

It would be wrong of me to tell people to go against the guidance given by the manufacturer. What I originally said was that it seemed that the manufacturer should maybe advise people to take it every day for a week to get accustomed to it as that seemed like common sense when people were having side effects which got better after about a week.

How people do things is up to them but I would be on dodgy ground, as a qualified clinician, if I was found to be advising people to ignore the guidance given with any drug

Took my first nalmefene yesterday at 5pm, felt very dizzy by 5.30 then detached and generally so unwell had to go to bed, then palpitations and other symptoms like migraine associated vertigo I had some years ago. Felt OK at 10, slept well, but this morning very dizzy and incredibly tired. How long before it gets out my system? I think I prefer to struggle with cravings - I'd resisted the idea of medication for months!

Took my first tablet on Friday and felt terrible soon after was going on holiday on monday so didn't have another but it is Tuesday now and my head still feels fuzzy wife had to drive

Some people get no side effects, others get quite severe ones. Generally, if they take a pill daily for the first week, the side effects are less each time until they are totally gone by the end of 7 days. I have also known people to have severe symptoms first time they take it, and have to go to bed, like you, and then experience no side effects at all the second time they take it.

I would say that the rewards are worth the initial pain for many people as the risk of relapse from abstinence is eliminated and one week of pain compared to many years of cravings seems to be preferable to most.

One of the main aims for us when we get clients started on it is supporting them through that first week and encouraging them to continue. It is the same as many medical treatments, like an operation on a knee that has been giving you pain for a long time... It will be even more painful immediately after the operation, but the idea of being totally free of pain later is the motivator

Can you tell me why after taking just one nalfemene on Friday I still have this heavy feeling in my head which is making it difficult to drive it's like a delay in thought process

It is a side effect, John. I am surprised it has lasted that long but it is common. As I said, when you get home and start taking it again, the side effects will subside each time you take one until they are completely gone after about a week.

Make sure you take plenty of rests while driving and stay safe.

Dear Paul

I am brand new here. Thanks for the great job you guys are doing. I heard that TSM might not work for people with gastric bypasses? any truth to this?

thanks

Hi Phil.

I'm not Paul and I am sure that he will be along soon to answer your question too, but I do have a little more information on this for you.

It isn't that TSM won't work for someone who has had a gastric bypass but that extra care is possibly needed over the dosage.

There are different types of gastric bypasses, but they all cause malabsorption of food, vitamins and most medicines.  As a result it's possible that the full dosage of tablet required for TSM may not be fully absorbed, and so therefore full protection from the tablet could be at risk.

So, using naltrexone (for example) may mean that of each 50mg tablet required, only 30mg may be being absorbed.  A doctor can compensate for this by potentially looked at an increased dosage on a step basis - ie 75mgs, 100mgs etc to make up for the shorfall so that enough medication is actually being absorbed as to still provide 100% opioid receptor blockage which is required for TSM to work.

It's something that should definitely be assessed by a doctor who is understanding of the medication and can make the adjustments that may be required.

I am sorry Joanna to have called you Paul. thanks for the information

Phil

 

Actually, Paul will be along to answer you too, Phil, I am sure.  He is also very knowledgeable about TSM.

I would agree with what Joanna said, Phil. I have never had a patient on TSM who has had a gastric bypass so I am afraid I don't have any direct experience of this scenario. However, whoever the surgeon is that did the gastric bypass should have specialist knowledge about how it affects the absorption of all drugs, including alcohol.

Dear Paul

what would your advice for a binge drinker be who usually drinks himself into a stupor in sequenzes of 1 to 2 weeks (weekends). Would you suggest to take Seilincro + AL every day for some time until i get used to it? The side effects are pretty tough to cope with i have to admit. Or should i take the pill only when i have the urge to drink.

thanks

Phil

The issue some people are finding with Nalmefene, Phil, is that the side effects are very difficult to deal with. They will cease as the body gets accustomed to the drug. However, if the use of TSM leads to less frequent drinking, which I would expect it to, a couple of weeks without a drink (and therefore without taking a pill) can result in a person having the same side effects they had when they first started. This increases the risk of a person avoiding taking a pill and that is obviously a serious problem.

A recent study by Stirling University has been scathing of Nalmefene and accuses Lundbeck, the manufacturer, of under-reporting side effects. I believe that this may result in approval for Nalmefene being withdrawn in the UK at some point.

Don't get me wrong, I have seen Nalmefene work very well, but the side effects are a serious problem.

We have stopped using Nalmefene for these reasons and our drug of preference is now Naltrexone. That is far more gentle (from a side-effect point-of-view) and we have seen fewer people failing to comply.

The problem with Naltrexone is that it is licenced for use with abstinence but that is an ineffective way of using it. That means it has to be prescribed 'off-licence' which is perfectly legal but you need a doctor who is confident enough to be able to justify prescribing it to people who will still be drinking.

I would recommend at least ASKING your doctor to consider the change to Naltrexone. Perhaps get some information from online to present to him/her and see if your prescription can be changed.

Some people don't suffer badly with side effects from Nalmefene and it is a suitable option for those people. I have seen people be successful using Nalmefene for TSM.

Thanks Paul, very informative. It is really the case theat the side effects are so strong that one considers to give up. What is a fact though is that it works very well, from 40 drinks in one sitting to 2 pints is strong evidence...i however need 3 days to fully recover from one Selincro+AL session

I will give Naltrxone a shot, thanks a lot

Naltrexone has the same effect and a lot fewer side effects for most people.

Hi Paul, am wondering what way naltrexone is taken (dosage-wise) compared to nalmefene, it being 50 mg compared to the 18 mg of selincro? From little bit of searching, I see that it's in two brands (perhaps more?), Revia and Vivitrol, are they just two different names for the one product and taken in same dosages? 

Started on selincro over a year ago, side effects were gone in a few days, but am still drinking daily (quantities reduced a bit, probably aided by the two-hour wait {or placebo effect!}!) and trying to keep to the 8-11 hour 'window' that you mentioned previously, taking it (generally) two hours beforehand and no less than hour and three quarters. However, things might be occassionally 'slipping through' at the other end, if drinking is started early in afternoon and continued until early morning, hence, perhaps naltrexone if taken more than once a day, might suit better (reluctant to take a second selencro in any one day, the 28 pills go quick enough taken one per day!) and only an hour of a wait before drinking, presumably, rather than two hours with nalmefene.. 

I guess it's down to experimenting to see if suits better, or not, and nothing to lose!

Also, was there something about it being a bit harder on the liver than nalmefene (perhaps due to the much increased milligrams?), and does one need to get a liver test done every year or so, to check that it's not acting-up?

Regards and thanks for your help,

Flat9

.

 

Liver tests once every few months may be insisted upon by the prescribing doctor when you are taking Naltrexone. It doesn't have the same impact on the liver as alcohol but as the doctor is prescribing that, he/she would want to keep an eye on things.

The dose for Selincro is 18mg once a day

Naltrexone is 50mg once or twice a day

Selincro two hours before the first drink, Naltrexone 1 hour before first drink.

Revia is oral Naltrexone and comes in 50mg pills. Vivitrol is injectable Naltrexone but there are also 50mg pills. There is no difference between the two brands.

Naltrexone costs about £30 for 28 pills, Selincro over £100 for 28.

Dear Paul

i have been on TSM with Selincro for almost 2 weeks now and unfortunatley have to say that the honeymoon was short. Day before yesterday i had my 5th selincro and funnily the side effects were gone, however i also went on a binge with total balckout and the rest of it. is this normal? or should i be worried (actually i am anyway)

It can happen, just stick to taking the pill two hours before drinking and make sure that you don't drink outside the window of opportunity (8-11 hours after taking the pill)

Also practice 'mindful drinking.' Listen to the signs your body gives you that it has had enough and don't carry on drinking through habit.

Sorry this is a bit rushed, I need to go out.

Hi Paul, eventually getting back.. As to Naltrexone vs. Nalmefene, was wondering why, since seemingly the same substance, just in a different form, one is metabolised in the kidneys and the other in the liver (perhaps it's not that important, but am curious as to why there would be a difference if basically the same drug)?

Also, was wondering what the 'half life' of naltrexone is ( i know that Nalmefene's is 8-11 hours)? Know that it's taken an hour before having a drink, but how long before you need to take the second one and, if for example, it lasts 4 hours, could one take a third one after 8 hours (if still drinking)?

Many thanks again for your help,

Flat9

 

It's not the same drug. It is the same type of drug.

Nalmefene lasts inthe body for 8-11 hours. Naltrexone is active for very slightly shorter, I tell my patients that it is around 8-10 hours but to regard it as 8 to be sure. The recommended daily dose for Naltrexone is 50mg twice a day. People shouldn't normally be drinking over more than a 16 hour period on naltrexone, that would suggest it isn't working and should be stopped.

Dear Paul

I am a bindge drinker and have started TSM about 3 weeks ago. The first 3 attempts were very sucessfull and i managed to stop at 6 drinks however the last 2 attempts were really bad. I fell in my old pattners of getting totally hammered and sigraced myself badly. There was'nt any change of behaviour other them maybe being eben more drunk due to the selincro. I guess you have heard this a million times though it really worries me since i now have the feeling that i drink even more with the pill than i did without

thanks and regards

Phil

Hello Phil,

How long before your first drink are you taking your pill? Also, how long after taking a pill are you having a drink? Are you drinking at all when not protected by a pill?

Hello Paul, thanks for coming back to me. I have my selincro a at least 2 hiurs before my first drink. I do not drink at all when i dont take the pill. In the moment i drink once a week (mostly Friday)

I woudl carry on as you are. The idea of TSM is that the problematic reward that people have from drinking is eliminated and the aim is to either get them back to more normal levels of drinking or for them to totally stop drinkig because it doesn't give them the same reward and they lose interest in it.

'Normal' drinkers sometimes drink too much. It is only an issue if that happens frequently. Try and do 'mindful drinking.' This is when you start drinking slowly to allow your body to get the message that it is not getting the same reward as it used to before you have drunk a large amount. Then stopping when your body says it doesn't need any more. Sometimes it is just habitual when people drink a lot. They always used to drink a lot so they have a tendency to still do that despite their body not demanding it. Pay attention to the message your body sends as you drink.

Dear Paul, thanks for your message

I do think that i had a signal from my body after the first swig of my beer that it isnt actually up tp it. However i kept on drinking. and i think once i was over a certain amount the pills didnt have any power anylonger

dear Paul

since i have an anxiety pronlem i was desribed valium and i also take citalopram and deanxit (thhese are the german names of the drugs)

Do you know if these meds will hamper the works of selincro? I haerd that benzos do..

thanks

Phil

Phil,

There are no known interactions between these drugs that could cause a problem. Benzodiazepines don't lower the effectiveness of Nalmefene (Selincro) as far as I have heard or experienced with my patients.

Thanks Paul, appreciate your help

Hello Paul

Would you see any problems to switch from Nalmefene (Selincro) to Naltrexon (Revia) without losing the already made gains? (i am in my 4th week and i see some results)

thanks

Phil

No Phil, that would be fine. We have done that with a number of our patients.

Dear Paul

I am in week 4, week one was honeymoon, week 2 and 3 i had 1 binge (20+ drinks, totally drunk) session  each. I thought i would change mys strategy and now try to drink more often but do it mindfully. I had 1 pint Wedesday and half a pint yesterday (with selincro) and i was easy to stop after that, Problem now is that I have cravings the next morning. Normally i dont have cravings for a week (from binge to binge). I cannot dake a Nal in the morning and have a pint, since i have to go to work....but i fell that the strategy works ebtter than tumbling from binge to binge

There is no reason why you would need to take a pill in the morning and have a pint for the sake of it, Phil. You take a pill only when you are going to drink and that can be any time of day. Just make sure you take the pill two hours before drinking and never drink outside the 8-11 hour period after taking the pill. Stick to 8 hours after starting your first drink to be on the safe side.

You are right to do 'mindful drinking.' This is essential. Listen to your body saying it doesn't need any more. If your body is happy with you drinking slowly, then do that. Don't gulp down 5 pints when you start drinking because then you have drunk a large amount before you receive the message that you really don't want to be drinking so much. While willpower is not a big part of TSM, paying full attention to the effect of the medication is and there is a need to try and break the old habit of drinking fast as soon as you have got through the two hour waiting time. (I am saying this for the benefit of others reading this, Phil, I know it has been explained to you already.)

Pharmacological extinction happens between 2 and 3 months on average but everybody is different and it can take much longer. Just know that if you protect yourself with a pill EVERY time you drink, you are heading towards that. Once you reach that, you will no longer get cravings.

Thanks Paul, as always very helpful and appreciated

What does TSM denote?

Thanks

It's a very successful medical treatment for Alcohol Use Disorder named after the physician who researched it over 20 years called Dr David Sinclair.

There a quick 5 minute read about it on this Patient site at this link.

https://patient.info/health/sinclair-method-for-alcohol-use-disorder

The Sinclair Method

Selincro

I am on Selincro now for week 4. SEs have largely gone however i have the feeling that the pill by itself curbs craving, When i take it the craving is gone in 5 minutes, i still do comply with Pill + AL though the half pint i drink is only for compliance reasons....without selincor though the cravings would be seriously hard to deal with...wanted to share this observation

Yes, I've had many people tell me that the tablet seems to reduce cravings - this could be down to side effects still lingering or placebo of knowing that you are taking an anti-craving type of medication.

However, most importantly, you are absolutely correct to always have a drink after the time has passed, regardless of how you feel - especially in the these early weeks.

The tablet is not curative on it's own and does not weaken the pathways in the brain that have been reinforced by continued drinking.  That process happens as a result of the endorphins being blocked by the Selincro, so if you don't have a small drink at least to release those endorphins, then they won't be released to be blocked.

The only mechanism that Selincro does is to block the opioid receptors in the brain, ready for that endorphin release from drinking to happen.

Thank you Joanna, I am a heavy weekend binge drinker with a normal craving frequency of 1 week. Now my pattern has changed, Since i take Nalmefen i have one drink with it and than stop. This one drink however triggers substantial cravings the next day so i take a nal and have a drink. Am i turning form a binger to a daily drinker? am a bit worried to be frank!!

4 weeks is still very, very early days.  This is a process that can take some months and during that time, things can, and often, jump around and change a bit. 

For starters, your brain has just suddenly been informed that despite being told it CANNOT drink under any circumstances, now it can.  That can mean that like a kid in a sweetshop it craves more because it can have the drink.  Over time, the novelty of that decreases.

The main thing is that if you have a craving, take the tablet, wait and then drink carefully and mindfully.  And then have patience, which I know is not our strongest trait!  At least, it wasn't for me anyway.

I can't say any more than what Joanna has said I have also heard people say that cravings reduce as a result of a pill on its own without a drink but the most effective way of using it is, as Joanna said, with alcohol.

Hi Joanna,

Just wondering if you’ve encountered any patient/s for whom, despite using Nalmefene as directed, did not find that it significantly reduced their drinking? I had been taking selincro for over a year, and for the last few months had been keeping to the ‘take the pill 2 hours before drinking and then drink within the 8-11 hour window’, and for a while thought that it was helping reduce consumption. But really I now think it was more a mixture of having to wait two hours (which reduced potential drinking-time) and possibly the placebo effect, as you mentioned, of knowing that you’re on an anti-craving type medication.

‘Had recently been thinking of alternatively trying to get prescribed Naltrexone to see if it has, in my case, any more noticeable results in reducing craving, but perhaps it also operates upon the same gene/form of opioid receptors as Nalmefene? I notice in Roy Eskapa’s book, pages 51-52, that there are possibly as much as 10% of patients (aside from those who cease taking the medication as described) for whom, in that example, Naltrexone does not appear to block their receptors. That brief mention in his book also had me wondering if the variants of the opioid antagonists (Naltrexone, Nalmefene, Naloxone, any others?) all target the same particular form of receptor (despite at least one ‘going through’ the liver, another through the kidneys), and if not all targeting the same type, is there a variation likely to benefit that estimated 10%? I have now stopped using selincro (ran out of pills a few days ago) and having discussed the idea of trying ReVia instead with my partner, on her suggestion have decided to skip medication and make efforts to develop greater mindfulness instead. If you are aware of a worthwhile alternative possibly worth trying, please let me know and I’ll give it a go.

Regards & many thanks,

Flat9   

Hi Flat9,

Firstly, can you clarify your comment that you had been taking Selincro for over a year, and for the last few months had been keeping to the 2 hour rule, please?  The reason I ask is it looks like you potentially weren't taking it as directed prior to that - maybe skipping the odd tablet or not waiting the required time or drinking past the protected time?  If this is the case, then you can practically write off everything but the last few months as it can not be expected to work if it is not being taken correctly.  As a result, you can really only say that you are just a few months into the method, and so when we say it can take some months to work fully, then you would start that from the period that you became compliant.

For clarification, compliant is taking the pill at the first sign of a craving, waiting 2 hours, and then drinking mindfully on it and not drinking past around 8 hours of starting drinking at the most.

Not being compliant can mean that your cravings actually get worse as the medication causes an increase (called an 'upregulation' of opioid receptors.  This means that if you are compliant one day, and then not the next, the endorphin rush has more opioid receptors to attach to and the therefore it reinforces the brain that drinking IS a rewarding thing as the brain basically got a double-whammy rush on the times you weren't compliant.  Cravings will dig deep and hang on because your brain knows that if it screams at you enough, it WILL get a good endorphin rush as some point in the future.  This makes the process much less smooth and potentially take much longer because the method is working against increased cravings and drinking due to prior non-compliance.

If this has been happening to you, that that explains why the medication didn't work well in the first months, and is then taking longer to work in the last few months.  Again, drink without protection again now and you are at considerable risk of undoing the last few months, too.

There is no real difference between Selincro and Revia (naltrexone).  The mechanism in the brain is the same and so results are about the same.  I haven't seen any test results that indicate one is better than the other.  If compliance was difficult on Selincro because of the 2 hour wait, then Revia does have an advantage there because the wait only needs to be 1 hour, not 2 hours.

You are correct in that around 10% of people do not respond to The SInclair Method using either naltrexone or Selincro.  There are some indications that this may be due to the type of MU Opioid receptor they have in their brain, but this as not been tested conclusively and no-one is crystal clear on why it just doesn't medically work for that 10%.  Testing what type of Opioid receptor someone has can be very expensive, so because TSM has a higher chance of working than not, it is usually just less expensive to start TSM, remain compliant, and see what happens. 

Of the results in clinical testing, around 75-80% of patients achieved a good reduction in cravings and drinking, and around 10% did not have it work for them despite remaining compliant.  So, this leaves rhe remaining 10% that it did not work for, which were due to not being fully compliant to the instructions and so they may up the remaining percentage.  From your post, it tends to indicate that you may have fell into that latter 10%.  If you were to continue on the method being compliant and using either naltrexone or Selincro then the chances are very high that you would fall into the successful group.  For 1 in every 10 people who are unfortunate enough to remain compliant and not have this method work for them, well you would be very unlucky to be that 1 in 10.  Plus, if you haven't been fully complaint then you will never know......

In all of the people that I have supported through this, we focus very much on continued complaince as well as looking to take advantage of what the medication does in terms of breaking the compulsion to continue and work towards chipping away at old habits in order to make positive changes.  TSM isn't just a case of taking the pill and drinking - it works much smoother with some additional work on the patients part.

I have had a few people that simply haven't responded at all to the method, despite full compliance and mindfulness, but out of the nearly 500 people now I have taken through it in the last 3 years, that figure is probably less than 20 - so much less than than the quoted 10% rate.

In terms of alternatives, yes there are always alternatives - Campral has decent results, for example - but again, total compliance to the directions are also required for that to work as it should. 

For the moment, you are in the situation of effectively not giving TSM enough time to work as it should.  You realistically need a minimum of 6-8 months of full compliance before you can write off either Selincro or Naltrexone as not working for you (ie. being in that 10% that it doesn't work for).

(Please note, all the above is based on my assumption from your post that you have not remained compliant.  This is how I read your post.  I apologise if you HAVE remained compliant and I have misread your post.)

 

Hi Paul

wanted to check in give a little update. Things are moving fast, too fast????

consumption pre-nal 30 drinks/week in one binging session

week 1 16 drinks

week 2 20 (in one binge)

week 3 20 (in one binge)

week 4 5

week 5 AF

week 6 AF

didn't have any cravings in week 5 and 6 hence didn't feel bothered to drink

cheers

Phil

 

Hello Phil, don't complain if it is working fast for you All looks very positive. Congratulations and well done!

Thanks Paul, not complainign at all, just not mentally prepared to see it working so well and fast, its just great, I did actually swap from Nalmefen to Naltrexone yesterday and its just so much easier on me. No SEs at all.

thanks for all your support, i am just so happy

cheers

Phil

Great to hear this, Phil

Dear Paul and users of Nalmefene. I am new to this site and realise I am a year late. I have been using Nalmefene for 3 weeks now only as needed, i.e taking it 1-2 hrs before an anticipated drink. It is definitely working for me. I am a scientific researcher and so have read all the research and clinical studies that have been done on the drug. I trust it. I have been keeping a record of how it has been working for me and compliance is a must. My side effects have been tough to get through but they have subsided some, agitation is now gone ( just this week) after I've taken it but insomnia is still persisting and this is hard for me as I have 2 small kids and a husband and I am trying so hard not to be agitated from the fatigue. My husband is supportive. I am aghast that this drug is not common knowledge like Nicorette is for cigarettes. 

My question is, does anyone know of someone who has taken this drug for say 2-6 months and is reduced to moderate drinking a year or 2 later. There is very little out there on the long terms effects of taking this medication. Except one study done by Dr. Sinclair on a 6 month follow up which was successful.

I have jused The Sinclair Method (TSM) with my patients for over two years now and have seen many that have succeeded in getting their drinking under control, including plenty who have simply stopped drinking once they lost that uncontrollable urge. I have seen nothing to indicate that the effectiveness is reduced as time goes by, although I can't claim to have validated research. It would be good if somebody did some.

The key is compliance. We believe that the success rate is higher than the 78% published success rate if only measured against those who fully comply.

We use naltrexone, rather than nalmefene, but the principles are the same.

If you have no pill with you and decide to drink anyway, the failure rate is 100% so that needs to be kept in mind.

*used

I took my 1 st Selincro last night, gave up with the system of trying to jump through hoops for NHS, not proud but 40 years nursing felt I needed to try. Firstly due to diary blind, only waited 30 minutes for a drink. Drank that as usual not really believing in any of the side effect. I felt so weird I went up to bed at 1800: tried to use my iPad for usual games to keep me occupied, no good really.Was going to try and curl up and sleep but I had the most beyond painful from hell colic. I really felt l might not see the morning, scary.

Hi I know you wrote this 3 years ago but I've no one to talk to as GP is off I'm having all the same side effects you had, did it stop or did you stop taking it. I couldn't work feeling like this.

Adele

The side effects do reduce.  Until they do, eat a good solid meal about 30-60 minutes before the tablet and drink plenty of water throughout, too.  Eating helps prevent the nausea and keeping hydrated helps to flush the medication through your system easier. 

Although the first tablet or two are the worse, it begins to subside over the coming 4-6 tablets.

The short term discomfort of the side effects far outweigh the long term benefits of the medication.