Walter 2020: naltrexone plus bupropion for binge drinking, a 12-person pilot

What they tested

Twelve men and women who binge drank often were recruited. Men needed at least five binge-drinking episodes a month over the past 3 months, and women at least three.

Everyone took extended-release bupropion 300 mg a day and naltrexone 50 mg a day for 12 weeks. The study was open-label, meaning everyone knew what they were taking, and there was no comparison group. Drinking was tracked with the timeline follow-back method, in which people recall their drinking day by day.

What they found

The share of binge-drinking days dropped from 19% (5.7 days a month) to 5% (1.5 days a month). On days when people did binge, they drank somewhat less: 7.8 drinks on average before, 6.4 on treatment.

The combination was generally well tolerated. Insomnia, headache and nausea or diarrhea were the most common side effects. Six people chose to stay on the medicines after the study ended.

Limits

• It had only 12 people and no placebo group, so the drop in drinking can't be credited to the medicines.
• Everyone knew what they were taking, which can shape how people report their drinking.
• Drinking was self-reported, and the study lasted only 12 weeks.

What it means if you're considering naltrexone

The authors call this preliminary and say the combination should be studied further for tolerability and benefit. The evidence that naltrexone helps with drinking comes from larger placebo-controlled trials of naltrexone on its own. This pilot doesn't show that adding bupropion does more.