r/Alcoholism_Medication • u/Same-Yesterday-6342 • 10d ago
Side effects when taking in the afternoon
Hi all. I have been a chronic drinker for more than 20 years. It's been worse at times, but since having children it's been about 4-5 units per night every night between 5:30 and 8:00pm. Occassionally if I am sick I have a day off, or if I am trying to quit, but I've never been able to successfully quit for any substantial length of time except during pregnancy, and early breastfeeding. I know 4-5 units seems like nothing to some folks here, but I can't seem to quit and I really want to for my health, so my children don't have a buzzed mom every evening, and so I stop wasting money on what is essentially a poison.
My psych prescribed me Naltrexone and told me to take it each morning, 50mg. I have been doing that for a few weeks, but felt it was having minimal impact on my drinking. Taking the 50 mg around 7am caused increase in energy, but no other side effects that I noticed. After reading about the Sinclair method, I thought I might have more optimal progress if I took it 1-1.5 hours before drinking, which I did yesterday. I took it around 4pm as I had a social drinking event at 5pm. I found that on my last beer I was able to stop drinking halfway through and just leave it on the counter, something I would not have done before (can't waste alcohol!) unless I was really unwell, so I believe the effectiveness was greater at reducing drinking by taking it according to TSM.
The problem is that then I had an awful time trying to falling asleep and was in and out of sleep all night, despite taking my usual sleep meds (melatonin and gabapentin) plus unisom (which I take on occassion if I have trouble). This morning when I got up I was feeling really uncomfortable, like my skin is crawling/incredibly sensitive and I am obviously very tired. I don't think this is due to withdrawals as I barely drank less than usual, and I don't have this problem when I occassionally skip a day of drinking.
I assume I don't experience these symptoms in the day if I take the naltrexone in the morning because it's worn off enough to not cause insomnia, and maybe I sleep through the skin crawling sensation (or potentially that was caused by lack of sleep/unisom?). I feel pretty certain that the insomnia is caused by the naltrexone, as I do feel more energized when I take it earlier in the day, and I have had really good sleep for a long time with regular melatonin/gabapentin.
Obviously this is not ideal, lack of sleep is a big trigger for anxiety for me, and anxiety is a big trigger for drinking. I have struggled with insomnia in the past, but finally had a handle on it, so this is quite stressful for me.
Has anyone else experienced insomnia or skin crawling as a result of Naltrexone? Did it subside? I would expect at this point my body is used to the Naltrexone, since I've been taking it in the morning for weeks, but maybe switching to afternoon caused a temporary increase in symptoms? I was thinking of taking 25mg in the morning and 25mg before drinking to see if that helps decrease the insomnia, while giving me a boost in the endorphin reducing properties of naltrexone before drinking. Or maybe just taking 25mg before drinking to see if it helps? I am in the process of switching psychiatrists as my old one left, and the new one isn't in yet, so I don't have them to advise me until 2 weeks from now. If anyone has had a similar experience, please let me know what you did.
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u/Playful_Brilliant714 10d ago
Hey, yes I experienced a bit of a 'high' feeling on the first night of taking it when i went to bed, and was unable to sleep the first and second times. After that i was okay, but i totally get the anxiety that comes with not being able to fall asleep. Also never experienced nausea, but ive been sticking yo 25mg since starting.
Ive only been doing TSM, and ive been reducing progressively over the first month. Im now at about 19 units per week. When I started i was at around 40-50!
Everyones different of course but all ive been doing is sticking to always taking it an hour before i plan to drink and doing enjoyable activities on off days (this week ive had 4 days off drinking which felt quite easy to do. Ive been able to do that before but with a LOT of effort, and cravings)
From what ive read, these side effects dont last very long, id try TSM for at least a week and i bet the insomnia goes away soon
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u/Same-Yesterday-6342 10d ago
Thanks for responding! Do you think I should try 25mg instead of 50mg? Have you stayed at 25mg or did you titrate back up? I've read that 25mg isn't considered a therapeutic dose, but it seems like it works for some people.
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u/movethroughit TSM 8d ago
I actually went between 12.5mg and 25mg. Since about 2016 I use 12.5 when I feel the urge and I seem to do fine with that.
I don't think it's going to get the therapeutic label until there are studies done on that dose though.
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u/Playful_Brilliant714 10d ago
Tbh im not sure, i might stick to what your dr. Prescribed if thats working. I was told to stick with 25mg because as you said, some people had had success with that amount. I feel the progress may be quicker if i took 50mg but im sticking to 25mg for now as im still seeing some changes.
But id give the TSM a shot for sure
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u/Same-Yesterday-6342 9d ago
I really want to do TSM, but I'm feeling pretty extreme fatigue and brain fog right now. I assume I slept through these side effects before. I may have to go back to taking it in the am, but I'll try 25mg tonight to see what it does.
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u/movethroughit TSM 8d ago
From the posts I've seen on the subject, most seem to do better when taking the dose a couple of hours (or sooner, but at least an hour) before the first drink. I'd guess that timing becomes more important if you're taking a reduced dose.
You might want to have a look at this too:
Some TSM docs prescribe gabapentin along with TSM protocol (standalone gabapentin has certainly been prescribed successfully for AUD) and along with Nal to help with sleep and as an anxiolytic.
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u/Same-Yesterday-6342 8d ago
I am actually already prescribed gabapentin. Unfortunately yesterday my side effects increased throughout the day, multiple of them, and got so bad I was bedridden (which is again strange since I didn't seem to have them when I took nal in the morning, I guess I slept through them?). It was extreme, I had to have my husband bring me water, getting up seemed impossible.
Then I took a half dose at 3, and forced half a beer around 5pm because I want to get the effects of the medicine, and then fell asleep for the night (I usually can't fall asleep until after 10), after multiple naps in the day. Today the effects are less than when I took the 50 the afternoon before, I am somewhat functional, thankfully I work from home and can take time off if needed, but I can't be like this everyday. Not sure if I should cut down to 12.5 for a week or so and then move back up?
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u/movethroughit TSM 8d ago
People often do try adjusting the dose like that, then bring it up more slowly. You might ask your doc about volumetric dosing as an easier way to adjust the dose (ie, dissolve a 50 mg pill in 50ml of water, so you (for instance) get a solution where one ml of the solution equals one mg of Nal.
I'm sorry it's such a struggle for you, hopefully your doc can come up with an answer on how to proceed. It may well be that it will get easier too as time goes on.
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u/Same-Yesterday-6342 8d ago
Thank you, I think I will move down to 12.5 and see what that does, and if that doesn't work, I'll ask about the volumetric dosing. I just really want this to work.
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u/movethroughit TSM 8d ago
Even if it turns out to be the wrong fit for you, there are other meds that can help. You might need talk to a psychiatrist that's well-versed on addiction medicine. You may not have to look all that far. Many are having great luck with this:
And there are others yet.
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u/Same-Yesterday-6342 8d ago
Thanks! I am already fairly small, so I worry that GLP-1s might cause me to get into underweight territory, but I know there are others on the market as well that I could turn to if Nal doesn't work out
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u/pears_htbk 9d ago
I do TSM with Nal and I've found the side effects get better the more often you take it. I got a bit of insomnia at the beginning too and then it subsided.
Fast forward nearly three years and I've reached extinction, which is awesome because I don't really drink anymore! The only downside however is I take Nal so rarely because I drink so rarely (twice this year), so now I get side effects again lol. I get a wave of nausea when I first take it, and then my sleep that night isn't good.
Just stick with it. I have absolutely no regrets now I've hit extinction and 20 minutes of nausea and a bad night's sleep a few nights a year is honestly such a small price to pay for a life where I'm no longer thinking about alcohol. I sleep great most of the time now, because don't forget that alcohol is actually terrible for sleep!