Naltrexone (50 mg/day orally)
Nausea, vomiting, headache, fatigue, and, at higher dosages, hepatotoxicity
Blocks analgesia from opiates needed for acute or chronic pain management.
Disulfiram (250 mg/day; range 125–500 mg/day)
If used with any form of alcohol, can cause a sensation of heat in the face and neck, headache, flushing, nausea, vomiting, hypotension, anxiety; and rarely chest pain, seizures, liver dysfunction, respiratory depression, cardiac arrhythmias, myocardial infarction, and death
Educate patients about avoiding all forms of alcohol (including products such as over-the-counter cough syrup).
Use only in reliable, motivated patients whose drinking may be triggered by stressful events; patients with impulsive behavior, psychosis, or suicidal thoughts are less appropriate candidates.
Avoid in the presence of renal failure, moderate to severe hepatic dysfunction, peripheral neuropathy, pregnancy, or cardiac disease.