Nalmefene is an opioid system modulator with antagonist activity at the mu and delta receptors and partial agonist activity at the kappa receptor
Nalmefene as-needed has been shown to reduce the total amount of alcohol consumption and number of heavy drinking days and to improve liver function and clinical status in two published 6-month studies in patients with alcohol dependence (1,2)
Nalmefene has a marketing authorisation in the UK for 'the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking risk level without physical withdrawal symptoms and who do not require immediate detoxification'
the summary of product characteristics states that a high drinking risk level is defined as alcohol consumption of more than 60 g (7.5 units) per day for men and more than 40 g (5 units) per day for women
NICE state (3):
Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence:
who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40 g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and
who do not require immediate detoxification
the marketing authorisation states that nalmefene should:
only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and
be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment
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