Naltrexone/Nalmefene (Selincro)/The Sinclair Method Hints and Tips

My best suggestion would be to have a quick chat with the prescriber who put the implant in for you.  They may have heard of it often and so put your mind at rest.

I am not medically trained so can't give you any advice on this.

However, I would expect that you had liver function tests etc prior to having the implant (yes?) and if there was a problem, I would not expect them to have given you the implant.

Hello Louise,

I believe the Bournemouth area is covered by the Dorset Clinical Commissioning Group and their list of approved medications is called the Dorset Formulary.

When I look up nalmefene (Selincro) here is what your local NHS has put in place for guidance on who is to prescribe the medication:

It is very important that both the services who will be providing the psychosocial support and the GP who will be prescribing communicate closely to ensure that the drug is used in accordance with its licence and the NICE guidance (TA 325). A patient should not continue to receive the drug if they drop out of the support structure. Whilst the drug is categorised as “amber” all prescribing including the initial supply will be the responsibility of the GP and the shared care is in place as the prescribing and support will be coming from different providers who need to communicate closely. Providers of psychosocial support are listed in the shared care guidance and accompanying flow diagram. Patients should be encouraged to self-refer to these services following their initial discussion with their GP. GPs should not initiate prescriptions until they have received communications from the support service.

I have a link to the actual instructions of the above mentioned 'shared care' agreement, so you can read it properly.  I can't post links on here so have sent that to you in a PM.

Joanna.

Hi Gav,

If you wish to use The Sinclair Method, then the medication to use is either naltrexone or nalmefene (Selincro).  There is no difference in terms of results with either of those medications, but Selincro is the one that is officially approved to be prescribed in the way that The Sinclair Method requires.  Be aware that not many physicians have heard it called The Sinclair Method.  Most are just aware that these are medications for Alcohol Use Disorder.

Acamprosate (Campral) cannot be used for The Sinclair Method (as it is not an opioid-antagonist medication like naltrexone or nalmefene) and is prescribed if someone wishes to try remain abstinent from the onset, whereas The Sinclair Method allows for a gradual reduction in drinking, and cravings, until abstinence is achieved and cravings no longer exist.

I am not a physician, and so cannot suggest which would be the better option/medication for your particular case.  You should discuss it with your own doctor who knows your medical conditions much better.

I have known many that have found that if they try remain abstinent immediately, then there anxiety and depression are hightened, whereas with a gradual reduction using the Sinclair Method, then there anxiety and depression reduces as their drinking decreases.  Everyone is different.

Yes, it does seem to be the case that naltrexone is more easily tolerated than nalmefene.

I do recall someone working on a synthetic medication but I am not sure if that is what you refer to.  I certainly don't know of any medications approved on the NHS other than antabuse, naltrexone, campral and nalmefene.

Under the NHS Constitution you have a right to be assessed for any medication suitable for your condition that has been approved by NICE for use within the NHS.

Good luck!

Thank you, Joanna, and sorry about the various spelling mistakes missing letters and separate words joined together in my post to which you replied: I wasn't under the influence when I wrote it, I was using a phone, and I'm awful at texting or writing messages accurately using it with my big finger and thumb tips!

I saw my regular GP on Friday afternoon (16 September) and we had a lengthy discussion bringing things up-to-date.  Unfortunately, he did tell me that a hospital doctor's letter to him (which I had not opened) indicated that I had had an apparent seizure, treated with benzodiazapines, on 17 August, so he said he had no option but to advise me not to drive and (as I knew having worked in insurance for a long time) that I would have to inform the DVLA (DVA in Northern Ireland) and surrender my licence, otherwise it would be revoked anyway.

He did talk me through various blood tests I had had and, while the relevant ones were strongly elevated on admission to hospital, they had all returned to within normal ranges, so he said that, if things remained "under control" (his words), there would not be any more seizures (as I do not have epilepsy), and there should be no problem in my licence being returned with blood tests being as they are now.

Incidentally, the GGT was never that high - about 150 on admission - it was the AST that was dramatically high on admission, but I had had been tried on an anti-depressant called Valdoxan (agomelatine), because my psychiatrist said it worked on melatonin and would probably help with my chronic sleep problems (which is how and why the alcohol problem started), but it has been implicated in liver problems and even liver failure, with particularly disturbing reports about it very recently, so, between my GP and psychiatrist, they agreed that I should stop taking that medication immediately as it WAS affecting my liver (the ALP and ALT were also well above normal, but the AST was dramatically high - over 400 units when I was admitted to hospital, but back down in the 40s within one week) without Valdoxan (and no alcohol, of course).

I did talk about the anti-cravings medications.  He said I would obviously have to work with Addictions' professionals within the local health trust, but he would have no objection to me using them as part of my recovery and would continue to sign-off prescriptions for any of them if the Addictions people and psychiatrist were agreeable to me taking them in the first place.  (He did say he had only heard of acamprosate (Campral) and disulfiram (Antabuse), but I said I wasn't encouraged by the fomer and, as I didn't want to die, I wouldn't take disulfiram (Antabuse)) and it was naltrexone or nalfemene that I wanted to try.  I didn't mention 'The Sinclair Method' - I don't think he would have known about it.

I should also say that he was pleasantly surprised by my appearance and build compared to the last time he saw me.  I am 6' 1" tall, but my weight had plummetted from 15st (admittedly a bit too heavy) and a 36" waist, to just 12st, and 32" jeans falling-of me, at the start of June, when I was clrearly malnourshed.  I weighed myself a few days ago and was back to 14st 6lb.  That'll be the lack of copious amounts of brandy and return to eating properly (probably a bit too much, as my anti-depressant has been changed to mirtazapine (which has weight gain as a notable side-effect and is acually also prescribed as an appetite stimulant)).

So, very early days but, so far, so good, except for the driving issue, of course.  But, had I not had that seizure, the exceptionally heavy drinking could well have continued, and dear-knows where I would be now, so I should count my blessings.

Thanks again, Joanna.

Gavin.

Check with your pharmacist or doctor, Bex, as I cannot answer that for you.

You must've had the medication for a while to notice it has expired, and if you chose to begin the method you must ensure that you have a constant supply of the medication, as you must never drink without it, so it might be best to start again and speak to the physician who originally prescribed it for you.

Hi Oka,

Yes in the beginning take the tablet 2 hours before you expect to drink.  Then drink mindfully and look for the opportunities to put the drink down earlier than what you expect to do.

As you progress with the method, then you would try waiting for the first sign of a craving, take the tablet, and wait 2 hours before drinking mindfully.

The difference between the two is that once you haven't gotten used to drinking on the nalmefene, you will be wanting to try and interrupt your usual drinking pattern.  So, by waiting until you get a craving, then you may find that you end up not craving that night so don't need the tablet or the drink.

The 10 hours period is the time that you can safely drink on this medication (so that means 2 hour waiting time and 8 hours drinking).  However, this is NOT a target and you want to be finishing the drinking session long before then if possible - which is fairly easily possible if you are drinking mindfully.

To clarify, it is absolutely NOT ok to not take the medicaiton and drink without it.  This will confuse you brain.  You are trying to teach your brain that craving is pointless because it won't get the endorphin rush from drinking.  You will still enjoy the other aspects of drinking, such as the taste etc, but not the endorphin rush.  Like a child in a sweetshop, if the parent never gives in to the crying for sweets, then eventually the child learns that it is not worthing crying for sweets because it won't get them.  If you drink without the medication on occasions, then your brain will continue to crave for alcohol because that if it craves enough, you will eventually give in and give it what it wants.

This method is a medical method for treating alcohol use disorder and so needs to be treat in the same way that if you doctor prescribed meds for cancer or diabetes, you would not mess with the instructions.

You absolutely do NOT take a drink without the tablet 2 hours before, period.  For this method to work as smoothly as possible, that is simply not negotiable I am afraid.

Lastly, depending on where you live, I do provide support for this method.  We can skype or talk on the phone if you are in the UK.

If you google search C3 Europe you will find the website.  Click the contact button and send me an email letting me know which country you are in and we can arrange to chat if you wish.  No problem with that at all

Thank you so much for the very clear advice. I am in Ireland. I'll look up your website and I will send an email😀 I will restart my process again from today. One more question, if I do not want to drink after taking the tablet (I didn't feel like it at the first few days because of the side affect) I do not need to drink? It seems rather stupid question but I don't need to drink to trick my brain?

Look forward to hearing from you.  I am away tomorrow for a few days so we shall arrange for sometime mid next week perhaps?

The tablet is not curative on its own, so even if you don't feel like drinking then it is worth just having one drink to release the endorphins.  This then moves you one step closer to the complete extinction of your cravings.  If you don't drink, you won't harm yourself, it's just a waste of a tablet though.

I am just surprised how little my GP told me about how to take this medication. And the instruction with the medication weren't clear to me either. Thank you so much. I already feel much in control now because I understand the process. The next week will be great. Thank you

Hi, would you mind telling me more about obtaining the prescription from your doctor please? Was he/she reluctant at all? Did you get your prescription on your first consultation or is there a process you had to go through? Also, did you have to attend counselling? Sorry about all the questions, I'm considering making an appointment but I'm quite apprehensive as to what to expect. Most importantly, how are you doing now, are these pills working for you? I know everyone is different but my drinking habits are very similar to yours. Thank you

Hi Perfect circles I was just reading other posts and realised that you had not had a response, Joanna advised me to sstart my own conversation on this forum you will get a responce from her then she is brilliant, however if I can help - I had to go to my local EDP group for 4 sessions and keep a drinks diary for 1 month then EDP wrote to my doctor who then released the prescription, I have to keep going to meetings to keep the prescription going which is expected to be for at least 4-6 Months.

I took my 5th pill last night and got to say that I feel great this morning, the first couple of pills were an absolut nightmare but only because I did not recieve the correct information on how to take them but Joanna has guided me through the past few days and things are deffo looking up.

Like I say above start your own conversation and I am sure you will get all of the advise you need through this forum.

Good Luck

Thank you Paddy, I will do. Are the EPD meetings 1-to-1 or in a larger group? I don't think I can face group meetings. Thank you for your advice