Naltrexone vs nalmefene: which is right for you?

Naltrexone and nalmefene are both used in the Sinclair Method, and they work the same way: taken an hour or so before you drink, they block the brain's reward from alcohol, so the pull fades over time. They are close cousins. The differences are practical, and for some people they point clearly to one over the other.

This is the one that catches people out. Both naltrexone and nalmefene block opioid receptors. So if you take opioid painkillers like codeine, tramadol or morphine, neither will work while you are on it, and if you are dependent on opioids either can bring on withdrawal. Nalmefene is not a way round this. If you rely on opioids, the Sinclair Method is not the right fit for now, whichever tablet you might use.

Naltrexone is processed by the liver and can nudge liver enzymes, so it comes with a simple liver blood test: at baseline, around one and three months in, then occasionally after that.

Nalmefene needs no routine liver monitoring at all. That makes it the better first choice, not a fallback, for two groups: anyone with a liver concern, and anyone who would rather not deal with blood tests. If needles are the sticking point, nalmefene takes them out of the picture.

Naltrexone is licensed in the UK for opioid dependence and used off-label for alcohol, which is routine, everyday prescribing. Nalmefene (Selincro) is licensed specifically for reducing drinking in alcohol dependence. Both are well established, and the licence difference rarely changes the decision.

• Naltrexone: one tablet an hour before drinking.

• Nalmefene: one tablet one to two hours before drinking.

• Nothing on the days you do not drink, with either.

Both can cause mild nausea, headache or tiredness in the first week or two, usually settling as your body adjusts.

Naltrexone is £89 a pack, nalmefene £105, both dispensed and delivered by us. The medicine is billed separately from the clinical service, at the same price on every route.

Naltrexone is the usual starting point: the larger evidence base for the Sinclair Method, and the simpler choice for most. Nalmefene comes into its own when a liver concern, or a real dislike of blood tests, makes monitoring the deciding factor. Tell us your history and we will point you to the right one. You can switch between them later if you need to, at no extra cost.

The online assessment is quick. A doctor reviews it and, if naltrexone is right for you, prescribes it, dispensed and delivered to your door.

Begin your assessment →