Nalmefene

How it works

It modulates the brain reward system through antagonism at mu and delta opioid receptors and partial agonism at kappa opioid receptors, reducing the reinforcing effects of alcohol.

Prescribing in practice

• Because it antagonises opioid receptors, nalmefene must not be used in patients taking opioids and can precipitate acute opioid withdrawal or block the effect of opioid analgesia.
• It is intended to be taken as needed on days when there is a perceived risk of drinking, and should be combined with ongoing psychosocial support focused on reducing consumption.
• It is not suitable for patients who require immediate alcohol detoxification or who have severe hepatic or renal impairment.

Monitoring

Monitor alcohol consumption, treatment adherence and continued need for therapy, alongside liver function where clinically indicated.

Counselling the patient

• Take one tablet on days when you feel there is a risk you will drink, ideally before drinking.
• Tell your healthcare team you take nalmefene if you ever need strong (opioid) painkillers.
• This medicine works best alongside support aimed at cutting down your drinking.

Evidence & guidelines

NICE recommends nalmefene, together with psychosocial support, as an option for reducing alcohol consumption in certain adults with alcohol dependence.