A number of studies have established the clinical efficacy of
naltrexone in the treatment of
opiate addiction. However, questions have been raised regarding its hepatotoxic potential and warnings have been given prominence in the package insert regarding its use for those with even less severe
liver disease. The current study monitored 53 male patients receiving
naltrexone 350 mg weekly for 12 weeks. The
lactic acid dehydrogenase (LDH) and serum glutamic oxalacetic
transaminase (
SGOT) levels were determined at pretreatment and at monthly intervals thereafter for three months. LDH and
SGOT were found to drop significantly from baseline over this three-month period. This decrease appeared most notable for those with pretreatment hepatic
enzyme levels exceeding the normal range. Moreover, changes in hepatic
enzyme levels were not consistently correlated with the patients use of
illicit drugs such as
opioids,
benzodiazepines,
cocaine,
barbiturates, and
amphetamines. Based on these data, we have concluded that contrary to cautions implied in the
naltrexone package insert, the benefit of admitting patients with the sole problem of elevated hepatic
enzymes generally exceeds the risk.