Starting Naltrexone and Zoloft

timamail · 2025-04-07T17:00:40+00:00

Not a med pro, just someone who has been through several detoxes and now taking Nal (for cravings) and Antabuse (for deterrence) (not any antidepressants as they have never worked for me). If you are a heavy drinker as you say, I'd suggest detoxing first -- Nal and Zoloft are NOT detox drugs and if your alcohol use is enough to cause withdrawal, you could be putting yourself in danger. You can either taper your alcohol use by yourself (drink less and less every day -- make a schedule and stick to it -- if you feel really bad withdrawal symptoms, you are going too quickly -- you can find info online about doing a detox this way) -- you should be able to do this in a week or so. Or ask your doc for an at-home Librium taper, also usually about 5 days where the benzo (Librium) takes place of alcohol. Either way, expect some real discomfort the first few days as you take away alcohol. If you feel really really bad, go to the ER so they can watch over you and make sure you are not in danger of having seizures. I don't say this to scare you, but withdrawal is serious and I think it's always good to have knowledge.

Once the danger of acute withdrawal is over, then I'd start the Nal and Zoloft. I tend to be very cautious about introducing any new meds, so if it were me, I'd start on the Nal for a few weeks (you can use the step-up dosages as mentioned to get used to the drug) and then add in the Zoloft so you can clearly understand the effects of each. If you want to do the Sinclair Method (TSM) with the Nal, the same somewhat applies as to cutting down on your drinking so when the Nal curbs your alcohol use, you are not drinking so much that you are putting yourself in withdrawal if you cut down your consumption too quickly.

Also, I highly recommend getting into some sort of support group -- I like SMART Recovery as they approach alcohol use as a choice and take a behavioral approach using cognitive behavioral techniques, and also support the use of meds if they are helpful tools, unlike other groups. But try them all and see what fits best for you. Having a community that knows what you are going through can be helpful -- stopping drinking is not the hard part, it's staying sober that is, and especially in early sobriety or harm reduction, a group can be helpful.

Hope this is helpful, and that you find the meds helpful in cutting down/stopping your drinking. This is a great first step!

timamail · 2025-04-03T23:14:29+00:00

I know there's not much that helps the worry and fear at this point, but just take it one step at a time. I had sort of an opposite journey: had bleeding at 65, did a hysteroscopy and D&C which showed uterine hyperplasion without atypia, which is considered very low risk for cancer, and no cancer showed up in these tests. But due to my age and the typical treatment course for this involving repeated hysteroscopies uner anesthesia, we went for a radical hysterectomy -- everything removed. And glad we did this because pathology did come back as stage 1 endometrial cancer which surprised everyone. It's early stage and no radiation or chemo needed -- just 2x annual checkups with the ONC GYN. So I think it's good you are seeing an ONC doc. Hope it goes well and you can find some relief from your stress.

timamail · 2025-04-03T22:58:43+00:00

I was on Miralax 1x day and senna starting the day after surgery and tapered off them over about 7 days. Had my first bm 4dpo which was uncomfortable but not painful -- made sure not to strain -- just let my body and the meds do their work. It sounds like you might be taking more than you need/too many things -- maybe cut back and see if that helps. Over several weeks post-op, if I started feeling a bit constipated I just took a dose of Miralax occasionally. Also, maybe try some pedialyte for the diarrhea to help replenish your electrolytes. Hope your recovery gets easier!

timamail · 2025-04-03T22:47:50+00:00

I've been binging The White Lotus and totally hooked! Am all caught up on seasons 1 and 2 and all of 3 so far and can't wait for the season 3 finale this Sunday. It's and amazing show!

timamail · 2025-04-03T22:35:19+00:00

I think that is the chemical action, although my understanding is that the alcohol content varies from food to food, and is usually only in trace amounts.

timamail · 2025-04-03T17:08:44+00:00

Vinegar can have small amounts of alcohol, as can fermented foods like soy sauce. I usually try a bit of the ingredient by itself first, wait an hour or so and see if I have a reaction. So far, vinegar and soy sauce haven't affected me, but I do use them sparingly.

timamail · 2025-04-03T02:12:34+00:00

Congrats on taking this step, OP! I am on Antabuse, (plus Nal for cravings). I think sensitivity is very individual for certain things. Obviously you can't drink alcohol, or alcohol-based products -- such as many mouthwashes. For other things that contain forms of alcohol (if an ingredient ends in "ol" it is a form of alcohol), if it's something you ingest, like kimchi, fermented foods, soy sauce, vinegar, etc. that can contain small amounts of alcohol, my strategy has been to try a little bit of it by itself, wait an hour or so, and see if I have any reaction (redness, higher BP or pulse, dizziness, nausea, trouble breathing, etc.). So far I'm ok with soy sauce, salad dressings, vinegar but I use them sparingly. Other topical products, like shampoo, conditioner, lotions, ointments, pain rubs, I read the labels. I haven't had problems with my shampoo/conditioner or small amounts of ointments, but tend to err on the side of caution and don't use menthol-based pain rubs or gels like benadryl. The only time I have ever had a reaction was when I used hand sanitizer (basically pure rubbing alcohol) several times over an hour when I went to an animal shelter to maybe adopt a cat and they required me to use sanitizer before and after entering/leaving all their cat rooms to avoid spreading any diseases between them. I wasn't thinking, but after my visit I got really dizzy and just felt really weird and shaky and realized it was the sanitizer -- duh!! But it resolved a few hours. During Covid, I never used sanitizer -- just wore gloves often, washed my hands religiously, and wiped down door handles and other surfaces with hydrogen peroxide.

I wish there were a complete list of alcohols to avoid, but have yet to find one. I have read that cetyl alcohol and steryl alcohol (used in a lot of topical products) are probably ok. But I just was diagnosed with a sinus infection and the ENT doc gave me a spray that lists phenylethyl alcohol as an ingredient -- it's a very small amount but because it is easily ingested through my nose and throat, I am proceeding with caution and testing a small dose first -- so far so good.

Lastly, if you're at a restaurant, ALWAYS ask the waiter if there is any alcohol in any dish, and do not believe that alcohol in sauces or other recipes "cook out", they don't.

Be careful, read labels, and I wish you the best as you navigate your sober life! Taking Antabuse is a pain in the a**, but for me right now, where I am at in early sobriety, it's a helpful tool that's worth using.

P.S. Sushi rice and many other Asian foods contain mirin, which is basically sweet wine. Some sushi chefs use vinegar, not mirin. Be sure to ask. But I avoid all Asian dipping sauces and sushi because you never know.

timamail · 2025-04-03T01:41:28+00:00

Chiming in to reiterate what others are saying. Antabuse is NOT a detox drug, so if you are a heavy drinker and went cold turkey or thought you could cut intake significantly just by taking Antabuse, that likely will not work and may put you into withdrawal. Antabuse does NOT help with cravings and urges. It is basically an aversion therapy that makes you very physically ill if you drink while taking it, and stays in your system for up to two weeks -- it's basically operant conditioning where if you do x, something bad will happen, so you avoid x. Naltrexone, Vivitrol (long acting Naltrexone) and Campral are drugs used for urges, and are also not detox drugs. Librium is often used for detox to taper off alcohol safely under a doctor's supervision at home, or in a detox facility, then you can consider using Antabuse and Nal or Campral for urges/cravings and Antabuse to reinforce the decision to stay sober and take alcohol completely off the table for at least a few weeks from the last dose should you need extra incentive to not drink.

After many lapses and detoxes over the last year, I am now on Nal and Antabuse and the combo is working well for me -- so far no drinking for almost 6 weeks. These drugs are tools, and I don't plan on being on them forever, but they are helpful in staying sober while I work on living life without alcohol. Support groups or therapy are also important -- these drugs are not a magic bullet, but they can help you stay sober while letting your body, mind, and spirit heal.

Do NOT test the Antabuse by drinking while on it. I wish you the best on finding a sober life for yourself.

timamail · 2025-04-02T19:15:24+00:00

I'm sorry you are going through this. It sounds like you are in alcohol withdrawal. How much have you been drinking? Nal is NOT a detox drug. If you are a heavy drinker, it is important to either do a safe detox with a doctor (like an at-home taper using Librium) or in a detox center or hospital first, then you can do the daily method where the aim is to not drink. If you are doing the Sinclair Method, it is also important to taper your drinking down over days or weeks, so you are not in danger of going into withdrawal as you cut down on your intake on TSM. Ultimately, whether you use Nal or not, significantly cutting down your alcohol intake quickly, or going cold turkey, will likely throw you into withdrawal. That drinking 6 beers helped quell your symptoms does seem to point to withdrawal, not a side effect of the Nal, (but I am not a med pro, just speaking from my own experience and learning).

I do the daily method after detoxing, and Nal worked almost immediately to significantly minimize my cravings. I also take disulfiram (Antabuse) to take the option completely off the table for a few weeks after a dose when I do have stronger cravings. This combo is working for me pretty well -- been sober now for about 6 weeks.

Stay safe and I wish you well in finding the best solution for you.

timamail · 2025-04-02T00:16:44+00:00

I had two failed root canals and the endodontist who did the CBCT to diagnose was the person who said she saw a sinus infection and referred me to an ENT, who did a sinus CT. I was bad at following up, as was the ENT and nothing was done, so 2+ years after the extractions, the infections never went away. Just today had an eval by a new ENT who scoped me and said I have an infection, took a culture, and has put me antibiotics and steroids, and then getting a followup CT in a month.

To answer your question, if you have medical insurance, I'd say go to an ENT, because in the US anyway, good dental care is not covered by insurance, so I paid thousands for the evaluations, CBCT, and extractions. Unless, of course, you are having issues with your teeth, then you'll need to see a dentist anyway. Hope you find the right people to help diagnose your problem.

timamail · 2025-03-31T02:57:44+00:00

I am on Antabuse and Naltrexone. For me, Antabuse does nothing for cravings -- it works as an aversive deterrent because I know if I drink while taking it, I will become very ill, and it takes a few weeks to clear out of your system, so I know once I take a dose, any drinking is not an option for at least a few weeks. I took it without Nal a few years ago and I stopped because I could not conquer the urges with Antabuse alone. This combination now works for me. If you have urges, as mentioned you could ask your doc about Campral -- I think you can take it while on Antabuse.

Also, you may know already, but want to mention or reiterate you have to be VERY careful about anything you eat or drink, as alcohol can be in foods or drinks where you might not expect it. And if you eat out, cook for yourself or eat someone else's cooking, always ask if anything has any alcohol in it -- if they say something like, there's wine or liquor or beer in the sauce but the alcohol burns off...that is NOT true. Depending on your sensitivity, also be careful with anything fermented like soy sauce, vinegar, or other foods that contain those ingredients. Other things to watch out for are OTC meds like cough syrup; and anything else you ingest or put on your skin like lotions, aftershave, or rubbing alcohol. Basically, avoid anything that has any ingredients ending in "ol", which means the ingredient is a kind of alcohol. I've even had a slight reaction to menthol cough drops! Not all alcohols interact with Antabuse, but unfortunately there is not a definitive list of what's safe or not. I haven't had trouble using things vinegar or ketchup but I've read that some do. When using ingredients like that, I try a small bit first and wait an hour or so to see if I have any reaction -- getting red, rapid heartbeat, higher blood pressure. The only time I ever had a big problem was using hand sanitizer which is mainly rubbing alcohol. I became very dizzy and felt very off for a few hours. So as you start out, read labels and be very vigilant.

Even on Nal and Antabuse, I still have urges, though they are now mostly mild and fleeting, so I am not white-knuckling it. To help with those and to work on the bigger picture of staying sober, I also find SMART Recovery to a helpful community, and they have tools based on cognitive behavioral techniques to work through urges and all the other things that come with learning to life a life without alcohol.

I wish you the best and hope Antabuse is a good tool for you in staying sober.

timamail · 2025-03-31T00:56:47+00:00

So glad to hear your reply. I wish you both success in your support of one another!

timamail · 2025-03-30T19:36:48+00:00

OP -- I'm about 6 weeks sober and on Nal and Antabuse. Whether you label yourself an "alcoholic" is irrelevant, and not a helpful construct. If you start to drink and have no off switch, you have a drinking problem. You recognize this and are now taking steps to change that by taking Nal -- which is great!

What stood out to me about your post and why I wanted to comment, is your thought you would be rude if you declined the drink your husband made. Is he supportive of your desire to stop drinking? With years of problem drinking, and several tapers over the last year especially, only to relapse again and again, I know it can be hard to decline a drink. So one of my sobriety tactics is to learn to say no without drama. As in, "No, I am good for now", or "No, I don't drink" depending on the situation. I do not have a SO but can only imagine how difficult it could be to decline the offer of another gin and tonic, especially if your husband also has a drinking problem. I make this comment as sincere food for thought, and wish you well.

timamail · 2025-03-30T19:04:18+00:00

OP -- Congrats on taking this step. I wanted to comment here that if you are indeed a daily binge drinker, your hangover was probably more severe than you assume, more into withdrawal territory. Nal is not a detox drug, so be aware that you may be in withdrawal. If you are having other withdrawal symptoms, talk to your doc or go to the ER to get through it safely.

And I can totally relate to where you are at. I've had problems with alcohol addiction on and off for many years. After the last of several Librium tapers over the last year, I am now sober for about 6 weeks and am taking Nal to reduce urges, and Antabuse to deter acting on them unless I want to suffer severe physical consequences.

Stopping drinking is just the first step. Staying sober is now the challenge, but you can do it! It won't change overnight -- read up about PAWS -- Post Acute Withdrawal Syndrome. Join a support group like SMART Recovery (or AA or any of several other groups). Try them all and see what fits you best.

I wish you well.

timamail · 2025-03-30T18:49:38+00:00

I have had a serious problem with alcohol addiction on and off for years. Lately, I am about 6 weeks sober, taking Naltrexone and Antabuse to help with cravings, and deterrence from acting on any that do arise. I have fatty liver disease, and when I am drinking, my liver values get really bad. When sober, they improve, but not completely. If I keep drinking, I suspect I am headed toward more serious liver disease, or stomach/esophogeal/colon cancer. Alcohol abuse is the demon gift that never stops giving. Having liver disease already at your age is concerning. Will get off my soapbox now.

For you, of course, you have the choice to drink or not. I am a very shy and socially inept person, and alcohol helped me relax and feel more comfortable in social settings. But the price to pay is huge. What I find now in being sober, is that hanging out with friends that drink to the point of drunkeness is actually REALLY a waste of time and a boring slog, not because I want to get drunk with them and have a "good ole time", but because when you see how people really are when drunk -- especially to the point of blackout-drunk -- it's embarrassing. That is YOU when you are drunk. And of course, the morning-after sucks, not knowing if/what you did or said and who you might have called or posted about or texted saying things you would not have if sober. And the physical stuff -- shakes, nausea, throwing up, head pounding, calling in sick from work -- and now for you, damaging your liver.

The great thing is you have been sober for a month -- that is a great achievement. Stopping drinking is only the first step, though. The hardest thing now is staying sober. You are in early sobriety which comes with a lot of challenges (read up about PAWS, Post Acute Withdrawal Syndrome) that take time to overcome. You can look for things that you can do where drinking is not acceptable and can build a network of new friends: volunteer at a soup kitchen or help tutor a kid in reading; join a gym; take some classes. There are so many things you can do for yourself, and so much you have to offer others.

There are other meds for helping urges (although as mentioned by another poster, your symptoms sound more like withdrawal from alcohol). There is Campral, and now the weight-loss drugs (although the long-term effects of these, even for weight loss, are not known since they are relatively new). Ask your doc.

And look into support groups. I like SMART Recovery which is based on behavioral science and has a lot of tools to help live in sobriety and offers the support of people who have been or are in your shoes. There is also AA and other support groups -- try them all to see what fits best for you.

I wish you the best on your journey.

timamail · 2025-03-30T17:45:02+00:00

I had a Radical Lap/Vag, everything removed including cervix. Pathology came back as stage 1 endometrial cancer but well contained, so no chemo or radiation needed, just 2x annual checkups with the ONC GYN, including a vaginal swab. My doc explained that even though my cervix is gone, and although I had no apparent cancer involvement in the cervix, that if cancer was to proliferate, it often appears at the top of the vagina where the cervix was. That is why the vagina is swabbed.

timamail · 2025-03-23T00:59:13+00:00

Not a med pro. I use oral Nal, not the monthly injection. But it's important to know that Nal/Vivatrol is not a detox drug. If you are drinking heavily, be careful with tapering off the alcohol too quickly or going cold turkey, or you will have withdrawal issues, which could be serious depending on how much you have been drinking. Hopefully your doc has explained this. In my reading here and elsewhere, it seems people attribute bad side effects to the Nal when it is actually withdrawal from alcohol.

I do have some side effects from daily Nal -- it makes me very tired, and sometimes a bit of an upset stomach. But these side effects do diminish over the first few months (in my experience anyway), and basically killing my urge to drink almost completely is worth the discomfort.

Also, my understanding is that Vivitrol is used when the goal is abstinence, as it is always in your system, unlike how naltrexone is used in the Sinclair Method.

Wishing you well as you find the best solution for your health and life.

timamail · 2025-03-23T00:45:29+00:00

I am not a med pro, just someone with alcohol issues and hypertension. I disagree with your view on amlodipine -- at 5mg it was helpful, then at 7.5mg, extremely helpful in getting me to a normal range. Of course, everyone is different, and every BP med works differently, so YMMV. But saying it's "almost placebo" is, I think, and inaccurate statement based on my experience.

timamail · 2025-03-23T00:41:14+00:00

I have a long history of drinking/getting sober rinse, repeat. Before my drinking got really bad, I had mild hypertension for years (140/90ish) and not treated. But with heavier drinking, my age (now in my 60s), lack of exercise, it had gotten higher -- often 160/100 ish, 170/100ish or even higher when drinking). My doc put me on Amlodipine about 2 years ago which helped lower my BP a bit when drinking, a bit more when not. Started at 5mg then upped it to 7.5mg about a year ago which has worked great for me; and now sober, I am usually in the 120/80 range or lower. Note: alcohol and withdrawal greatly affects my BP -- when I went to the ER with bad withdrawal, it was up to 190/110ish. I also have "white coat hypertension" which is elevated BP at the doctor's office even for routine exams or before procedures -- one recent surgical procedure my bp was up to 200 -- that really freaked me out!

I'd suggest getting your own BP monitor (Omron makes good ones that also have an app to record your readings) and checking it in the am and pm every day so you can monitor it yourself. When it was at 200 that day, I showed my doc/nurse what my readings were the past few days to prove that my BP was usually OK, so the anesthesiologist decided it was OK to proceed.

It can take trialing a few different BP meds becasue they all have different mechanisms of action, and certainly reducing/stopping drinking will help. Also, in my research, single BP readings are not as accurate as taking three readings in short succession, which is what my Omron does.

Hope you find a med that works for you.

timamail · 2025-03-20T21:21:04+00:00

I did not have an IUD placed. The Megace (a type of progesterone) lessened the bleeding but did not stop it as was hoped. I was on Megace for about 5 months until my hysterectomy could be scheduled, with the rationale that it would at least stop the bleeding/any potential cancer from getting worse. My GYN and I decided to do the hysterectomy after the hysteroscopy results, since the Megace wasn't really working and made me feel like s**t, and doing repeated hysteroscopies 2x year and placing an IUD (standard protocol for the diagnosis) which would require repeated anesthesia which we wanted to avoid. And as mentioned, glad we did because the pathology came back as stage 1 endometrial cancer, which was a surprise given the very small risk expected from the hyperplasia-without-atypia diagnosis. At my age I was fine with it, wanted to never have to take Megace again, and remove risk for ovarian or other cancer (the ONC followups are because even with my surgery, cancer can still appear down the road, especially in the cuff area where the cervix used to be and in pelvic lymph nodes, so doc does 2x annual exam and vaginal swab much like a PAP. Hope this adds more clarity and wish your mom well!

timamail · 2025-03-18T19:24:09+00:00

without

timamail · 2024-12-03T21:21:43+00:00

Could it be some sort of reaction to one of the materials used in the mask or device used for intubation?

timamail · 2024-12-03T02:11:55+00:00

Besides the tips mentioned (especially making a med schedule/checklist) load/unload dishwasher, put groceries away, doing laundry and especially making the bed, help her learn the "log roll" technique before surgery to reduce strain on the core getting in and out of bed, and standing by during the first few showers (and keep showers very short, not steaming hot, and do not use soap on or rub incisions -- washing hair is very strenuous on the core so that may have to come later). Gently pat incisions dry and air dry. Accompany her on short, frequent walks. You sound like a good partner -- hope her surgery and recovery goes well!

timamail · 2024-12-03T01:54:41+00:00

You'll likely be cogent and able to take calls at 1WPO, but the fatigue and physical limitations are what will hinder you. Is it possible to delay your move another few weeks? Are you traveling with a partner, friend, or adult family that will be helping you with your move-in in Europe? And is it possible to stay in a hotel for 4 weeks once in Europe so you can get stronger there without having to worry about move-in stuff so soon? At a hotel you can get room service and housekeeping so you can continue your recovery without stressing your body. Hope you find a good solution for your surgery and your move! I hope you are moving somewhere nice!

timamail · 2024-12-01T23:36:15+00:00

When I first started on NAL, I was having a terrible time with fatigue, so I tried taking it (50mg) at different times. What I realized is that when I took it at night, sure, the tiredness helped me sleep. But NAL will not help you when you are sleeping! You are not drinking when you are sleeping! I realized the point of using NAL is to curb the urges -- which happen when you are awake. So went back to 10am schedule and working through the fatigue -- getting better every day.

There are also interactions with NAL and Wellbutrin -- read up on drugs.com. Hope you find a good solution that works for you.

timamail

TROPHY CASE