A Powerful Alternative for People Who Do Not Respond to Naltrexone

Many people looking to reduce their alcohol consumption will have heard of naltrexone, one of the most widely studied medications used in alcohol-related treatment pathways.

However, what happens if naltrexone doesn’t provide the response you were hoping for?

This is where Nalmefene may be considered.

Nalmefene (sold in the UK under the brand name Selincro®) is a prescription-only medicine licensed specifically for reducing alcohol consumption in adults with alcohol dependence who continue to drink at a high-risk level. It works on similar reward pathways to naltrexone but has some important differences.

At The Drink Less Method, Nalmefene is not typically considered a first-line option. However, for some individuals who do not respond adequately to Naltrexone, it may represent a useful alternative following clinical assessment and approval.

How Does Nalmefene Work?

Like Naltrexone, Nalmefene works by targeting the brain’s opioid reward system.

When alcohol is consumed, naturally occurring chemicals known as endogenous opioids are released. These contribute to activation of dopamine-based reward pathways, reinforcing drinking behaviour.

Nalmefene modifies the activity of opioid receptors in the brain, reducing the rewarding effects associated with alcohol consumption and helping to reduce the urge to continue drinking.

Many people describe this as:

• Feeling less driven to continue drinking
• Finding it easier to stop after fewer drinks
• Experiencing reduced anticipation or excitement around alcohol
• Feeling more in control of drinking decisions

Is Nalmefene More Potent Than Naltrexone?

Although the two medicines are closely related, Nalmefene interacts with opioid receptors slightly differently.

Research suggests Nalmefene may bind more strongly to certain opioid receptors and remains active for longer than Naltrexone. Some researchers have proposed that this stronger receptor binding may explain why certain individuals respond better to Nalmefene after an inadequate response to Naltrexone.

Importantly, this does not mean Nalmefene is automatically “better” than Naltrexone.

For many people, Naltrexone works extremely well and remains our preferred first option. However, where Naltrexone has not produced the desired response, Nalmefene may provide an alternative approach.

What Do the Clinical Trials Show?

Nalmefene has been studied extensively in large international clinical trials.

The major ESENSE 1, ESENSE 2, and SENSE studies evaluated nalmefene in adults with alcohol dependence and high drinking-risk levels. These trials demonstrated reductions in:

• Heavy drinking days
• Overall alcohol consumption
• Drinking risk levels

compared with placebo when combined with behavioural support.

In pooled analyses from the ESENSE studies:

• Heavy drinking days were reduced significantly
• Total alcohol consumption fell substantially
• Quality-of-life measures improved in many participants

These findings formed part of the evidence supporting approval of nalmefene in Europe and its recommendation by NICE for specific patient groups.

Why Might Someone Switch From Naltrexone?

There are several reasons a clinician may consider Nalmefene:

• Limited response to naltrexone
• Continued heavy drinking despite treatment
• Individual variation in medication response
• Clinical preference following review

As with many medicines, individual responses vary considerably.

What works well for one person may be less effective for another.

Does Nalmefene Have More Side Effects?

One important difference is that Nalmefene tends to produce side effects more frequently than Naltrexone.

Common side effects include:

• Nausea
• Dizziness
• Headache
• Insomnia
• Sleep disturbance
• Fatigue
• Feeling generally unwell

Fortunately, these effects are usually mild to moderate and often occur when treatment is first started. In many people they improve as the body adjusts to the medication.

This is one reason why many clinicians will often try naltrexone first before considering nalmefene.

The Drink Less Method Approach

At The Drink Less Method, naltrexone remains our primary treatment pathway.

However, we recognise that not everybody responds in the same way.

For individuals who have not achieved satisfactory results with Naltrexone, Nalmefene may be considered following clinical assessment.

Our clinicians will review:

• Your response to previous treatment
• Current drinking patterns
• Medical history
• Current medications
• Suitability for alternative treatment options

before deciding whether Nalmefene may be appropriate.

The Bottom Line

Nalmefene is a licensed medication specifically developed to help reduce alcohol consumption.

It works on the same reward pathways targeted by Naltrexone but may have stronger receptor activity and a longer duration of action. For this reason, some individuals who do not respond adequately to Naltrexone may benefit from Nalmefene instead.

While side effects can be more common, clinical trials have shown that Nalmefene can significantly reduce heavy drinking and overall alcohol consumption in appropriate patients.

Important Information

Nalmefene (Selincro®) is a prescription-only medicine and is not suitable for everyone. Treatment is provided only following clinical assessment and approval by a qualified prescriber. Individual results may vary.

www.drinklessmethod.co.uk