Side effects- Nalmefene ( Selincro ) v Naltrexone.

Yes Paul and I wish I was one of those people ! I would just like to say to people considering Selincro to please go for it if you can. I may well be one of the few that has had such a reaction to the drug. The first few days on the drug in a lot of people can be unpleasant but it does reduce after that week. When I was taking it regularly the side effects were not a problem really, although I would say looking back my mood was a little flat. ( Which is why alcohol days without the need for the drug is best ) 

I should also say that I would not be in this much better situation now of having control over my drinkingif I had not commenced Nalmefene ( Selincro )  Just a shame I could not continue on it as an infrequent 'as required dose ' 

Yes that is correct but it is not licensed for use as Nalmefene ( Selincro ) It also cannot be prescribed initially by a GP. It has to be via Specialist Services.

Who told you a GP can't prescribe it?

Not a GP won't prescribe it, but that they can't?

"The decisions around what is included in the guidance and the rating, green, amber or red, is made by the committee as a whole which has representation from across the health organisations in Coventry and Warwickshire including the Coventry and Warwickshire Partnership Trust.

 

The APC guidance is however advisory and individual medical practitioners can prescribe any medicine available to the NHS as appropriate to the patient needs after clinical assessment."

 

In my experience, it is HIGHLY unlikely that a NHS GP will ever prescribe naltrexone in the UK, unless they have a direct experience of AUD issues.

The reason is because it is only on licence for those that have already stopped drinking and to help with their cravings.

If someone was to turn up at their GP surgery and indicated they are having issues with cravings, then the likely response is that they would be best served by being under an alcohol specialists care, in which case the alcohol services would prescribe, if appropriate.

If you were a GP and have a family to care for and a mortgage etc etc and can't risk any potential investigational issues, do you feel that you would either:

a) prescribe any medication that the local health authority as deemed as specialist care only, and therefore take ALL of the responsibility for the patient's care. and have to deal with any issues that may follow (and let's face it, people with addictions are probably more likely to NOT follow prescribing instructions etc, therefore making any potential comeback more likely)

or

b) play it safe and follow the local health authority's instructions so therefore reducing any potenital issues for the GP to zero?

As much as I don't wish it was the case, it is simply a fact that the majority of GP's will follow the local health authorities instructions because then they can't go wrong.

Joanna,

but look at my response and the question asked.

Rayboy250: It also cannot be prescribed initially by a GP. It has to be via Specialist Services.

RHGB: Who told you a GP can't prescribe it?

Not a GP won't prescribe it, but that they can't?

Where did I say anything factually incorrect. Had I said it is highly likely that a GP would prescribe it of his own accord, that would have been a different matter. My GP can prescribe Campral, but he won't, can not and will not (for whatever reason) are two different things that should not be mixed up.

Oh I agree with you absolutely RHBG and you didn't say anything incorrect at all.

I was just saying that, on top of all the other issues you and I are seeing about prescribing, for a GP to prescribe naltrexone would ALSO include prescribing it out of license, which makes it even less likely.

Hell, we can't even get them to prescribe medications that are approved for the reason we want them prescribing for, can we?

Trying to get naltrexone from a gp not only has all the issues we are already facing, but someone wanting it for use with TSM would also be asking a GP to prescribe it against the NICE instructions.  It just won't happen!

In theory a GP 'could' prescribe naltrexone to someone who is already abstinent.  But to ask a GP to prescribe it to someone who intends to drink on it, is asking a GP to go against NICE guidelines.  Unless a GP is VEY compitent in AUD, I cannot imagine any GP would be happy to do that - the potential fallout for them it it all went wrong would be massive.

But, as we know, Naltrexone does absolutely nothing for alcohol cravings unless used with alcohol to recondition the opioid receptors. It is a scandal that a drug is licenced with advice to use it in a way it is totally ineffective and not approved for use in a way that would actually help people.

Absolutely, Paul!

I should point out that I do not mean to talk down Lundbeck, the manufacturers of Selincro.

They were, after all, only protecting their investment in Selincro.  They have also been extremely helpful to me, in providing me with the tools I need to be able to provide the required counselling/support required to get the medication.

Directly, Lundbeck have helped many got off this horrible AUD merry-go-round.  Indirectly, they have also helped so many others by allowing C Three Europe and C Three Foundation access to the required learning so that we can provide the support for free.

It is importat to note that without Lundbeck, this treatment would not be an option on the NHS - period.

If you read up on the side effects they sound similar but other folks experience does not seem to bear that out. The only draw back is that you need Liver function review on naltrexone but that is easily sorted either throigh your GP or on line.

Yeah, left is fine

I mean LFT results are fine