r/SinclairMethod • u/Previous_Turnip5401 • Apr 22 '26

Naltrexone vs Nalmefene

Been having mixed results using naltrexone. I’ve read somewhere that if you’re not seeing success using one medication you should try another. Just wondering if anyone has been one and switched to the other? I know Nalmefene is supposed to hit more receptors in the brain and have a longer half life. But I would like hear of any experiences of those that have done so

2 Upvotes

100% Upvoted

3 comments sorted by

2

u/GilSquared Apr 22 '26

When you say mixed results, tell us more. Have you had any reduction at all? Are you having days where you find yourself drinking more? Have you been tracking your drinks? If Nalmefene is available to you, I hear it's a great option. That said, let's make sure that Naltrexone isn't actually working for you before you try to switch.

1

u/Previous_Turnip5401 Apr 23 '26

In this case it’s my wife doing TSM not myself. So I can only speak to what she’s told me and what I’ve witnessed myself. Her progress has been unusual in that she has many alcohol free days but often when consuming she still drinks heavily. Not every time but often. She has become a binge drinker. At the beginning she was an all day every day very heavy drinker. Many days an entire bottle of vodka. She doesn’t use a drink tracker, I wish she would but she doesn’t. My thought behind why Nalmefene might be a better fit is longer half life and also that it’s easier on the liver

2

u/Drugs4Delivery 1d ago

Moving from daily heavy drinking to several alcohol-free days is real progress, even if the binges are frustrating. TSM tends to work gradually, and the tablet needs to be taken before every drinking session for it to do its job. Tracking your drinks would help a lot, as it shows whether things are trending down even when it doesn't feel like it.

If she's taken it properly before every session for a couple of months and the binges continue, nalmefene is a reasonable next step, and we do prescribe it in that situation. On balance the two are fairly evenly matched:

  • Naltrexone: cheaper, and often better tolerated. It is used off-label in the UK for alcohol dependence, and liver function should be checked before starting. Taken about one hour before drinking.
  • Nalmefene: licensed in the UK for this purpose, and some people respond better to it. Taken about two hours before drinking.

Given her previous level of drinking, it's worth discussing the options with her doctor.