In this episode of The Good GP, host Dr Krystyna De Lange speaks with Dr David Leitinger, a GP with a special interest in addiction medicine, about the practical use of naltrexone for managing alcohol use disorder (AUD).
Dr Leitinger explains how naltrexone, an opioid antagonist, disrupts the endorphin-mediated reward of alcohol consumption, helping patients gradually reduce intake and unlearn habitual drinking behaviours. He highlights that naltrexone can be prescribed while patients are still drinking, not only during abstinence, and discusses flexible prescribing methods including daily dosing and the “Sinclair Method” of targeted dosing prior to drinking.
Important considerations covered include contraindications such as concurrent opioid use and the approach to temporary cessation if opioid analgesia is needed. Dr Leitinger reassures that naltrexone is generally safe in patients with liver disease and recommends baseline and follow-up LFTs, though testing should not be a barrier to therapy.
A case study illustrates practical patient outcomes, expectations, and follow-up. Strategies for supporting patients through lapses and individualising success measures are discussed, as well as where naltrexone fits alongside other first-line options like acamprosate. The value of harm reduction and ongoing patient support in primary care is emphasised.
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