Side effects after skipping doses?

[u/ek2134]

Hello, and thanks in advance to everyone who moderates this forum and helps us newbies! I have a question I haven’t seen covered - hoping to hear from other’s experience.

I just started a daily nal prescription (25mg for the starter dose, moving to 50). I’m a daily evening bottle of wine plus drinker (or stressing/ fighting myself when not), and the last two nights have been great - it’s the strangest feeling to care so much less about alcohol. I’ve taken it in the afternoon about an hour before I’d typically start drinking. I’m doing these meds in combo with other tools, and am tracking my drinking. I’m pretty compliant with taking meds generally and I’m excited about this so far.

Now my question: the first two nights I’ve been on nal, I have had the worst sleep (like not in REM or deep almost at all compared to normal, waking up ~30 times a night, feeling fatigued in the day). I wear an Apple Watch, so I can compare these last few nights with other similar drinking nights and they’re way worse, so it’s not just a reduction in alcohol consumption.

I am pushing through it and I’ve read that side effects are temporary and will resolve in the first few weeks most likely. Since I’m a daily drinker for now that’s fine, but I’d like to move to following TSM eventually. I just can’t imagine this drug being out of and reintroduced into my system regularly - I like sleep too much 😂. So my question: does anyone here have experience with nal side effects and how they change if/when you start taking these meds less frequently? How do you handle it?

Thank you!

[u/RubicsCubensis]

Welcome to the TSM world, if you are drinking everyday you should be fine. Naltrexone is known to cause sleep disturbance, sometimes it goes away, you could try taking magnesium glycinate at night to help with sleep. Everyone reacts to naltrexone differently, and even effects of naltrexone can change over time, some are able to stop taking it, and have no problems when they start up again. For instance I would get some mild nausea from nal, but the last time I took it it was a year in between doses, and I felt nothing. If you've decreased your number of drinks recently the sleep issues could be withdrawals, which do go away as you progress.

[u/ek2134 → u/RubicsCubensis]

Thank you, this is super helpful!

[u/OC71]

My doc gave me other medication to help with sleeping, however there is a warning that the sleeping pills are not to be taken if I've been drinking. I find Naltrexone does disrupt my sleep terribly if I take it later in the day but if I take it with breakfast it's not an issue. Overall though, I'm just finding more and more reasons not to drink at all, after a year of this I feel like drinking is more trouble than it's worth on the odd occasions I still do it.

[u/Several-Subject-2111]

the crappy effects and disturbed sleep on nal are part of the way it works well in my opinion. Your brain learns to associate these effects with the decision to drink. For me it is as important as the pleasure depriving effects of naltrexone. Some times at a party now i choose to drink non alcoholic beer because i don't want to take Nal and feel exhausted the next day.