nalmefene hydrochloride dihydrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
nalmefene hydrochloride dihydrate: clinical details
Prescribing considerations
- Confirm alcohol dependence, current consumption, withdrawal status, treatment goal and need for detoxification before prescribing.
- The licensed population remains at high drinking risk following initial assessment and can engage with continuing psychosocial support.
- Review psychiatric comorbidity, seizure history, opioid exposure, planned surgery, and hepatic or renal impairment.
- Not established for people younger than 18 years; clinical experience in older adults is limited.
- The product contains lactose.
Contraindications and cautions
- Hypersensitivity to nalmefene or an excipient.
- Current opioid agonist or partial-agonist treatment, recent opioid use or dependence, suspected recent opioid exposure, or acute opioid withdrawal.
- Severe hepatic impairment.
- Severe renal impairment.
- Recent acute alcohol withdrawal syndrome, including hallucinations, seizures or delirium tremens.
Monitoring
- Track alcohol consumption, overall functioning, engagement with psychosocial support and adverse effects.
- Assess new, persistent or atypical psychiatric symptoms and ongoing suicide risk independently of nalmefene treatment.
- Monitor hepatic and renal function more closely where mild or moderate impairment is present; use caution with substantially elevated transaminases.
- Ensure clinicians know the timing of the most recent nalmefene exposure if emergency or planned opioid treatment is required.
Clinical pharmacology
Nalmefene antagonises mu and delta opioid receptors and is a partial agonist at kappa receptors. It is extensively metabolised, principally through UGT2B7-mediated glucuronidation, with renal elimination of metabolites; its terminal half-life is approximately 12.5 hours.
Formulation and product differences
- The selected product is a white, oval, film-coated oral tablet engraved with “S”.
- It contains lactose and should be swallowed whole rather than divided or crushed because direct skin contact can cause sensitisation.
nalmefene hydrochloride dihydrate preparations and strengths
Tablet
Route: Oral
Strengths: 18 mg
nalmefene hydrochloride dihydrate interactions
Tell the prescriber and pharmacist about all prescribed, over-the-counter and recreational substances, especially opioids.
Opioid painkillers, such as morphine or oxycodone
Nalmefene may reduce or prevent pain relief; emergency opioid use can require specialist monitoring.
Methadone or buprenorphine
Concurrent use is contraindicated because nalmefene can block opioid effects and may precipitate withdrawal.
Opioid-containing cough, cold or antidiarrhoeal products
These products may not work adequately and should be checked with a pharmacist or prescriber.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.