Opening Statement:This case demonstrated increased musculoskeletal pains directly related to naltrexone ingestion. The symptoms were diminished when the dose was decreased.
Patient Background Information: This 27-year-old, white man reported daily use of alcohol for 11 years with heavy drinking for 5 years. He had one previous instance of abstinence for 9 months in 1992-1993. He also uses marijuana and has done so for 14 years. He reported withdrawal symptoms of shakes, headaches and sweats, and had experienced blackouts while using alcohol. He had one previous outpatient treatment, which resulted in the period of abstinence for approximately 1 year.
Naltrexone Treatment and Results: Naltrexone therapy was initiated on 2/17/94 at 50 mg per day in the morning. He reported an immediate decrease in craving, but on the visit on week 4, he reported leg cramps and sore ankles, which required acetaminophen (Tylenol) for relief. These symptoms persisted and were particularly painful on the 10th week's visit (4/21/94), when he complained of pain in both ankles that occurred by noon after taking a 7:00-Am dose of naltrexone. He used 5 Tylenols to relieve the pain, and had abstained from taking naltrexone with no ankle-pain following the day of withholding treatment. Physical exam revealed no external findings of crepitus, tenderness, or inflammation in the knee joints. His dose was diminished to 1/2 tablet per day, and on the return visit on 5/12/94, the patient admitted a decrease in ankle pain on the 1/2 tablet. His craving history was significantly reduced on naltrexone and continued to be effectively blocked at the lower dosage. To our knowledge, the patient has remained abstinent, although he was lost to follow-up soon after the completion of week 12 of the study.