Opioid antagonist helps heavy drinker cut down alcohol intake
Q: I have been a heavy drinker for 35 years — just in the evenings, after work. I would take six or eight drinks nightly, waking with a hangover almost every morning.
I spoke to my doctor last year about naltrexone. Since starting naltrexone, I have been able to manage my drinking. I limit it to no more than one or two drinks daily.
On some days, I have skipped alcohol completely. My prescription ran out a couple of months ago. At first, I was able to limit my intake. However, it has increased to the point where I am returning to my previous consumption levels. I will be seeing my doctor in a few days, and, as much as I hate relying on a drug for help, I will be asking for a renewal on the naltrexone prescription.
A: Naltrexone (ReVia, Vivitrol) is an opioid antagonist. That means it blocks the effects of opioid medication, as well as natural opioids (endorphins) in the brain. Scientists think it is these endorphins that are responsible for the pleasure some people get from drinking alcohol.
Studies show that naltrexone can be effective, especially when combined with counseling (New England Journal of Medicine, Aug. 14, 2008; Journal of Substance Abuse Treatment, February 2018).
Q: I have been diagnosed with Type 2 diabetes. I’ve been trying to control my blood sugar levels with the help of a nutritionist for about a year now. I am thin, work out regularly and eat really well. It’s not enough.
My doctor has now prescribed metformin. What are your thoughts on this drug? And do you know of anything else I could try? I am still asymptomatic and feel great. I wish I could help myself through diet and exercise.
A: Don’t give up on your good diet and exercise habits! They will help with the effectiveness of your treatment, even if you haven’t been able to control your blood sugar with them alone.
Metformin is a first-line drug for Type 2 diabetes, as well as one of the oldest and best-studied. It improves the body’s response to insulin and can be quite effective. In addition to its ability to keep blood sugar down, metformin also has shown promise for its anticancer activity (Acta Biochimica et Biophysica Sinica, online, Oct. 7, 2017).
There are potential side effects, however. The most common are digestive: nausea, stomachache, indigestion, loss of appetite, diarrhea and flatulence. The most serious side effect, lactic acidosis, is rare, but you should be alert for the symptoms: abdominal pain, irregular or rapid heart rate, low blood pressure and anxiety. Such symptoms signal a medical emergency.