How to take Naltrexone on a full life schedule

You could've started last night, as many of us suggested, since you had a day off work today.  But you chose not to.  Your decision.

Not harsh at all.

Before I chose to get this pill I picked up a lot of extra hours this month for a co-worker out on surgery.  You're right I find the time to drink.  BUT, I cannot miss work, outpatient, group therapy or the fact that I'm in the midst of a step process getting a new upper denture made.  Sorry for the post.  I know you mean well.  Had I not picked up the extra hours at work I wouldn't be in this bind. I just got so involved in the forum and everyone talking about this pill that I got excited. I also got excited about outpatient and therapy that I made appointments for that.   I'll make a decision to start now or wait til June. Until I try it I will be done with questions as I understand your point. Its easier to control my drinking the day before work than is to wonder how I"ll feel the day after a new pill.  When I do try it I'll update everyone.  Thank you.  

The biggest reason I chose not to was because I got no sleep the night before.  I was scared that mixing my "feeling off" and the med would not be good.  Also, an alcoholic will make any excuse but my husband knew how upset I was about not seeing my kids on Mother's Day.  Him taking me to eat cheered me up.  

Not a problem, that was your decision to make.  But then so is the decision but when to start.

This really is a method that you need to take ownership with.  You need to be as able to commit yourself as you do with any other treatment method out there.

If you are not ready yet, that is not a problem.  You will be ready when you are ready.  I was just trying to point out to you that in the say way that AA suggests 90 meetings in 90 days (which they expect you to take ownership over) then this method needs your respect and commitment, too.

Thank you!  It is 12:00 pm here.  Maybe if I take a pill around 2pm I'll feel ok for work at 3 pm tomorrow.  24 hours on 1/2 a pill could work.  Will have to decide.   If I start this month it will be this week.   Thanks for the advice.  I've heard of some people with side effects but some not having any.  Did you start out the correct way?  Eating, then the pill, then drinking? 

Yes,I ate and took half a pill and the same the next day and then onto a whole pill on day 3

I'm on Nalmefene now as that's what gets prescribed in the uk but does the same job

And Nalmefene has an even worse reputation for side effects. Still, some people don't notice any difference at all from taking it, except that they suddenly don't want to drink as much. 

Am sure I read somewhere that it was Inadvisable to split the tablets, or maybe I dreamt it!

Nalmefene (Selincro) should be taken whole. Naltrexone can be split.

Aah thanks for clearing that up for me. Knew I'd read something about not splitting them.

Yep, ADEfree is absolutely correct.

The reason that Nalmefene cannot be split is because in testing, it was established that there is a risk of skin irritation.

Thank you!

Might be good to write down a checklist for starting Naltrexone, just something brief.

Have you checked the meds you're taking to make sure none contain any opioids or coedine or similar? Especially important as you're having dental work done and you don't want any of that stuff in your system when you start Naltrexone.

Thanks for the info on the checklist.  I have written down info from this site along with info from the book.  I also made a copy of the chart in the book of when I start, the dosage, the amount I drink, etc....

I have checed my meds and everything seems to be O.K.  I take Buprorion (which I read is often given with Naltrexone for weight)  I also take Nortiptyline 10mg every other night and also clonazapam.  Although my doctor and the pharmicist say it's ok to take the clonazapam with Naltrexone I will be cutting the evening dose in half.

I'm not actually having dental work.  I'm just getting a new upper denture made.  The steps are just taking impressions and so forth.  Nothing actually done directly to my mouth.  Just taking all measures for a good fit.  

Thank you. 

 

Good deal, Kelly.

"Although my doctor and the pharmicist say it's ok to take the clonazapam with Naltrexone I will be cutting the evening dose in half."

Does your doctor say it's ok to do that? Just want to make sure you don't run into a problem cuttting it back so suddenly. I've never taken benzos myself, but I hear that tapering is usually how it's done. 

I take 1 mg in the morning and 1 mg at night.  My doctor did say it would be fine to take a .5 mg at night instead.  I don't plan on going off the clonazapam just yet so cutting back by 1/2 a mg total will be fine.  

Excellent!

You might also want to google Slow Wave Sleep to see if there are things you can do to improve your sleep hygiene. As you cut back on the alch, it's going to help a fair bit, but there may be other things you can do to help you get down into that level of sleep where your body can repair itself more effectively.

There's also a website called Calm (dot) com that you might want to have a gander at. It has some nice, relaxing scenery and sounds and offers guided meditation if you feel like plugging into that part of it. Smartphone apps too, so you can get a quick chill-out on short notice. 

It's funny.  When I quit drinking cold turkey whether it was for a week, 2 weeks or even when I had a month my sleeping was better the 1st night.  Anytime I have a night without drinking I sleep great.  But, if the pill can cause some insomnia I will definitely look into that.  

My family doctor prescribed this for me but I don't think she's fully aware of how it works.  She just called it into the pharmacy for me.  So, I just contacted a doctor that comes to my place of work.  He participates in TSM.  He said it's OK for me to take 1/2 of the pill for the next few weeks since my schedule is busy.  He said I should up it to a full tab June 2nd which is when I have 3 days off of work.  

So, I'm making arrangements to start tomorrow night and if I have to wait a week for my denture so be it.  I also have a nerve test planned for Wednesday but rescheduling and praying I don't have to wait too long to get back in. 

So, that's my plan.  Thanks for sleep info.  I wrote that in with my notes.

I can't put links on here but I read where  Dr. Eskapa said 25 mg is fine at all times so I feel better knowing that for 3 weeks I'll be O.K. at that dose. It's actually on a TSM post from 2013.  

Thank you so much for putting up with me.  

Please will you PM me that link Kelly, as I cannot ever remember Dr Eskapa saying that 25mgs if fine at all times so if he has written this then I will need to ask him about it.

There might be the odd exception to the rule, in the same way there might be someone who needs slighty more than 25mgs but these cases are, as far as I am aware, individual and usually for a reason specific to that person and then discussed with their doctor.  For example, someone needing slightly more may be someone who has had a gastric bypass since that affects the absorption of both food and medicines.

ALL the clinical tests show the optimum dose for TSM being 50mg of naltrexone.

I sent the link to you and I also sent a private message on TSM website.  Still waiting for a response.  I'm more concerned about taking half a dose for 3 weeks which is why I sent a PM asked about the doctor at work who participates in TSM if this could be correct and also did some research. LIke I said, still waiting for a response.  

Thanks for the link Kelly, I appreciate that.

For those interested to know, a question was placed to Dr Eskapa from someone saying that due to side effects, he had reduced the dosage down from 50 mgs to 25mgs and this appeared to be suitable for his drinking time which was around 1-2 hours.

Dr Eskapa responded as such:

Answer from Dr. Eskapa

If you are responding well to 25 mg naltrexone 30 minutes to an hour before drinking then by all means proceed. There are individual differences in metabolism and absorption of the medication. Some doctors prescribe 100 mg naltrexone ... but the studies reported are based on 50 mg, as you said. In this case taking a larger dose will not speed up the de-addiction process. As long as the opioid receptors are blocked so that there is no reinforcement coming from the endorphins released by alcohol, then you will be extinguishing the addiction. Just as the addiction is not learned overnight so the de-addiction (pharmacological extinction) process takes time.

Kelly, this appears to be one of those rare cases I mentioned in which the individual and length of time drinking means that perhaps 50mgs was not suitable for THIS person.  Notice he had started off at 50mgs initially.

I take from Dr Eskapa's response the wording ''If you are responding well to 25 mg naltrexone 30 minutes to an hour before drinking then by all means proceed.''

This is unique to this individual and Roy did NOT say that 25mgs is fine at all times.  You are reading into it what you want to see.  For this one particular individual it appears to be fine for him.  He had already started at the correct dose and then for HIM, 25mgs appeared to be doing the trick - which would also be due to the short 1-2 hours that he drinks in the evening.  It is very, very rare that someone needs less of a dose.  You are highly unlikely to be that person, too.

Everything about this method suggest that everyone starts on the 25mgs and then increases to the 50mgs as soon as is tolerable, and as quickly as possible.  That is what Roy Eskapa wrote in the book, that is what Dr Sinclair also wrote in his research.

If you try sticking with 25mgs for as long as you intend, you may well be finding that only some of the endorphins are blocked.  That leaves some of the endorphins to reach the receptors in your brain and if ANY of those endorphins get through, you may as well not start at all until June.

You MUST block all of the endorphins - the door needs to be shut and locked, period.  For by far the largest majority of people the studies showed that 25mgs was not enough to do this.

I am sorry, but this really seems like you are grasping at straws with regards to changing the criteria to fit you.  In the 2 and a half years I have been doing this, and the almost 250 people that I have taken through the method, I have never had anyone need to lower the dose - ever. 

 

Hi Joanna

My progress seems to be slow as I'm still drinking up to 2 bottles of wine.I don't mind slow but I'm worried that because my drinking often spans a whole day I'm letting some of the endorphins in

I was just asking about what the doctor who practices in TSM told me at work - that I could take 25 mg for 3 weeks and then up it to 50 mg when I have more time off work.  He did say if that is working for me after 4-5 days I should "definitely" up the dose.  He also said that I DO indeed need to up the dose then but starting at 25 mg would be o.k.

Sorry, I am not grasping at straws.  I want to do this the correct way and I am proud of myself for the research I've been doing because in no means do I plan on giving up whether that is going by the pill or cold turkey again.  I am a strong willed person and I have a postiive attitude which is why I OVER research everything.  

I am not the girl who was on here last week feeling down.  When I feel positive about something I follow through.  You are extremely intelligent when it comes to TSM but that does not mean I shouldn't ask other people questions who know about this also.

I am an open minded person and open to all suggestions.

I agree, Kelly, absolutely.  This will be your TSM journey, no matter when you chose to start it.  I am not a physician, and don't claim to be.

These threads come up very high in the google ranking searches.  I was concerned to check up on exactly what Dr Eskapa wrote because your post saying that he wrote that 25mgs is fine AT ALL TIMES was likely to have been misread.  I didn't want others to have read that and taken it as a green light to only use 25mgs.  That is how misinformation gets out there and we are talking people's lives here.  It's important to get it right.

I know Roy Eskapa extremely well and he has never, ever indicated to me anything other than 50mgs, except in quite rare individual and sometimes complicated cases.  Like Roy, I am extremely eager to ensure that the correct information is out there at all times, and if something is incorrect then to ensure it gets corrected.  That is what we both promised Dr Sinclair that we would work to do - to ensure that his legacy is on the internet as true to his research as we could make it.

You can, and will, do whatever you decide to do.  But, in my opinion, you are over-researching on the side effects issue, fearing the worst.  Once people have been on 25mgs for a couple of times, the jump to 50mgs is usually very small.  It doesn't cause a big issue.  And if it suits you better, you could go from 25mgs a couple of times, to 37.5mgs a couple of times and then to 50mgs.  It that takes a week to do, then it is (in my combined experience of everyone I have taken through this method) much better than staying on 25mgs for 3 weeks in fear of what might happen when you go to 50mgs.

 

That could be causing you a problem, yes.  Even a few endorphins getting through as the medication wears off is going to be giving your brain a bit of a rush so it will find it harder to let go.

With nalmefene, you have a window of around 11 hours, from the moment you take the pill, during which the nalmefene is active in the body.  So, if you for example took the tablet at noon, then you should not be drinking past 11pm (I even go a little earlier to be sure and would suggested you don't drink past 10pm).

If you look at when you take the tablet, do you exceed that 11 hour 'window' or do you get close to it?

The other thing to be aware of is mindfulness when you are drinking.  Just because you have that window available, it isn't a target in the sense of meaning that you CAN or SHOULD still be drinking so close to the limit.

Being aware of the sensations and feelings when you are drinking, and drinking the first few drinks slowly, should enable you to recognise that, actually, drinking isn't doing what it used to do.  It isn't as exciting, or as thrilling, or as satisfying as you remember it to be.

When you do that, between drinks ask yourself if you really, really want another.  As soon as hear the message from your brain that it says no and is satisfied, then you need to act on that message.  You have two options at this point - either act on it or continue drinking, even though it really isn't feeling that good.  If you don't think you are hearing the message to say you've had enough, it might be that it is getting lost in the 'chatter' going on around you.  So, until you get used to listening for it, and hearing it, have the next few drinking sessions alone with no radio or tv, and nothing to distract you.  Turn everything off and really concentrate on those first few drinks and how you feel.  Write it down if necessary.  Once you get used to hearing it, it will be much easier to identify with the normal everyday life things going on around you.

You can also do little things to start chipping away at your old habits.  For example, if you normally drink at noon, make yourself wait until 12.30 or 1pm.  Buy a smaller glass so that you have less alcohol per drink.  Buy one and a half bottles instead of two.  These little things to find are unique to you because you know how you drink.

Thanks for the advice

I will make a big effort to put my drinking off till later and pace it more so I'm not slugging it back

Hmmm...maybe I am over researching.  I'm being cautious to something that is new to me.  What happened to follow what your doctor tells you?  Mine said that 25 mg would be fine for 3 weeks.  I wasn't sure I agreed with that so I looked more into it.  

I feel like I'm back in AA.  

Going to take the 25 mg tomorrow night and and Wednesday night - since I cleared my schedule due to the fact that you were correct in one thing.  If I put drinking ahead of everything I'd find the time for 2 days to take this pill so that I did.  If I feel O.K. I will up the dose to 50 mg.  If not, I'll quit on my own.  I blew 11 years of sobriety due to over confidence that I could drink again socially.  I know that is not the case. I am not a social drinker.  But, I do know there are many ways to get sober.  I really want to give this pill a chance so forgive me for looking into something that I never in my life heard of that sounds "too good to be true."  You've had a long time experience with this.  I have not.

I'm really not trying to argue with you.  Like AA I am taking what I want and leaving the rest.  You gave me a lot to think about and I truly thank you for that.  Please accept the fact that I'm also an intelligent person just looking out for my best interest with something that is truly new to me.  I'm an alcoholic.  I overly think and possibly over research but both of those qualities will get me somewhere I need to be. Better than not thinking at all.

I think if you feel fine on 25mg 2 days in a row then take the full tablet,if not leave it at 25mg for another day

That is what I plan to do. I only have three days to keep it at 25mg.  Then I can up it to 50.  Thank you!

Doctors make mistakes sometimes.  Most are wonderful, but some are clearly not.  You are right to do your own research too.  And when over 120+ clinical trials suggest that taking 25mgs and then upping to 50mgs as soon as possible gets the best results, then that is what you should adjust to try and do.  Which is what it seems you have

If you just followed what the doctor said who prescribed it to you, then you would be taking one a day, every day regardless of whether you drink or not.  This was disproved in clinical trials over 10 years ago!

I don't want to argue with you, Kelly.  There is nothing wrong with taking what you want and leaving the rest.  I am just trying to be sure that you don't leave something behind that is extremely important to the success of this method.

Nicole, along with Joanna's suggestions, for drinking at home I've found that pouring the drink (opening the can in my case)  and taking a sip, then getting it away from me (I put it back in the fridge) and getting up to something else for a bit seems to work well. Don't keep the glass close to you, better that it's out of sight so you don't have the same cues that power the old habit. At the least, don't hold the glass in your hand, but actually knocking out some little task before the next sip leads to longer times between sips and gives you an opportunity to "forget" about the drink for a bit. I got so absorbed one time that it was an hour before I went back to retrieve the can again. Maybe you can give it a go if you want the 2nd/3rd etc. drink. 

Trouble is I feel the need to drink all the wine I have in the house so I need to restrict what I keep in the house

Understood. That will change in time. Just be on the lookout, as at some point, somewhere in the process you will begin to notice a snippet of indifference. The mindfulness technique can help you uncover it earlier so you can build on it.