Alexander DeLuca, M.D.
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Ten References on:  Naltrexone and Eating Disorders
Compilied by Alexander DeLuca, June 2001; Added reference #1: 4/29/2003

Jarosz,P.A.; Metzger,B.L.
The obese Zucker rat (OZR) exhibits a hyperphagic eating pattern similar to the obese binge eater. Dynorphin, an endogenous agonist of the kappa receptor, is associated with regulation offood intake. Lessened sensitivity to opioid antagonists and/or increased central dynorphin levels may contribute to the hyperphagic eating pattern observed in the OZR. This study examined the temporal effect of a single intracerebroventricular (ICV) dose of nor-binaltorphimine (NBNI), a specific and long-lasting kappa opioid antagonist, on food intake, body weight, and satiety measures (meal size and the shape of the cumulative food intake curve [CFIC]) in adult male OZRs. Analysis of individual subjects revealed a differential response to opioid antagonism with respect to weight loss, reduction in food intake, and change in the slope of the CFIC, with some responding and others responding poorly. Repeated-measures analysis of variance showed a significant decrease in body weight (P = 0.001) and food intake (P = 0.03) in responders compared to poor responders and controls. Satiation was influenced to a greater extent in responders, who showed a significant reduction in meal size and a greater change in the CFICfor the largest meal of the day toward a pattern of satiation. These data suggest that a differential response to chronic opioid antagonism may exist in the OZR
Biol.Res.Nur. 3(4), 198-192

Marrazzi MA; Kinzie J; Luby ED
A detailed longitudinal analysis on the use of naltrexone in the treatment of bulimia
In accord with our auto-addiction opioid model, naltrexone was previously reported to be effective in the treatment of bulimia in a controlled double-blind clinical trial with a randomized cross-over design. This is a detailed longitudinal analysis over a 16 month period of one subject from that study. Attenuation in bulimic symptoms in two- drug as compared to no-drug periods was demonstrated. The duration for which the drug was needed was also addressed. The subject is an illustration of a therapeutic response on multiple parameters including binges, purges, urges to perform both behaviors, eating patterns, scaled feelings and Eating Disorder Inventory questionnaire scores. A rare allergic reaction to the drug is reported. It appeared to be heat and photosensitive, even in the presence of sun screen, occurred after a delay and did not appear immediately on skin testing. Use of naltrexone after desensitization is also reported
Int Clin Psychopharmacol 1995 Sep ;10(3):173-176

Marrazzi MA; Markham KM; Kinzie J; Luby ED
Binge eating disorder: response to naltrexone
Binge eating disorder (BED) is characterized by a bulimic binge eating pattern without the compensatory behaviors of purging or laxative abuse. It is often associated with obesity. The treatment response characteristics are more like bulimia than other forms of obesity. We have shown the opiate antagonist naltrexone to attenuate bulimia nervosa in controlled clinical trials. We report here a response to naltrexone in a subject with BED similar to that previously reported for the larger population of bulimic subjects. Three consecutive periods of drug, placebo and double dose drug were used, with the order of the first two periods double blind until after the data analysis. Symptoms were reduced in the naltrexone compared to placebo period. Statistical significance was demonstrated using time series analysis for this 'n of one' study. Psychotherapy was carried out throughout all periods. Naltrexone plus psychotherapy may be more efficient than psychotherapy alone
Int J Obes Relat Metab Disord 1995 Feb ;19(2):143-145

Chatoor I; Herman BH; Hartzler J
Effects of the opiate antagonist, naltrexone, on binging antecedents and plasma beta-endorphin concentrations
The effects of the opiate receptor antagonist, naltrexone, were examined on antecedent thoughts of binging and plasma beta-endorphin concentrations in an adolescent girl who was hospitalized with bulimia nervosa. Significant decreases in urge to binge were obtained during naltrexone administration compared with control sessions. Baseline plasma beta-endorphin concentrations for the bulimic adolescent were not different from those of nonbulimic controls, but plasma beta- endorphins increased significantly during naltrexone administration. After discharge from the hospital, the adolescent refused to take naltrexone because she felt she could not deal with her life without the "pleasure of binging." The case points to the interplay of biological and psychological factors in bulimia nervosa
J Am Acad Child Adolesc Psychiatry 1994 Jun ;33(5):748-752

Armeanu MC; Moss RJ; Schoemaker J
Ovulation induction with a single-blind treatment regimen comparing naltrexone, placebo and clomiphene citrate in women with secondary amenorrhea
Secondary amenorrhea is often associated with emotional stress, weight loss, eating disorders or polycystic ovary-like disease. Involvement of the endogenous opioids in the pathophysiology of hypothalamic amenorrhea, by inhibition of hypothalamic GnRH secretion, has been demonstrated in some cases. Chronic blockade of the endogenous opioids with the long-acting opioid antagonist naltrexone could result in increased gonadotropin secretion and ovulation induction in these cases. A single-blind ovulation induction protocol comparing naltrexone, placebo and clomiphene citrate was evaluated in eight patients with secondary amenorrhea. Naltrexone proved not to be more effective than placebo in our study. Only one patient ovulated on naltrexone, one on placebo and four on clomiphene citrate. The latter therapy caused a better endocrine response. In conclusion, although ovulation could be incidentally induced by naltrexone, this drug did not appear to be more successful than placebo and clomiphene citrate for ovulation induction in this population of patients
Acta Endocrinol (Copenh) 1992 May ;126(5):410-415

Jonas JM; Gold MS
The use of opiate antagonists in treating bulimia: a study of low-dose versus high-dose naltrexone Sixteen individuals with bulimia consented to a 6-week trial of naltrexone, receiving either standard dosages of 50-100 mg each day or high dosages of 200-300 mg each day. At the end of 6 weeks, individuals in the low-dose group had no significant change in their frequency of binge eating or purging, while individuals in the high-dose group had significant reductions in both behaviors. Four individuals in the low- dose group who were crossed over to high-dose naltrexone at the end of the study went on to experience significant reductions in binge eating and purging. These findings support the potential utility of opiate blockade in treating bulimia, but suggest that dosages of naltrexone greater than those needed to block exogenous opiates may be required for therapeutic efficacy in reducing binge eating and purging
Psychiatry Res 1988 May ;24(2):195-199

Jonas JM; Gold MS;
Naltrexone treatment of bulimia: clinical and theoretical findings linking eating disorders and substance abuse
Eating disorders and substance abuse may occur together frequently. Studies have demonstrated that 25%-50% of individuals with anorexia nervosa and bulimia will have a history of substance abuse, and that certain groups of drug abusers may have elevated rates of eating disorders. One mechanism which may explain this relationship is the role of endogenous opiate peptides in triggering the compulsion to binge-eat. The authors report the successful use of the long-acting opiate antagonist naltrexone in treating a group of bulimic individuals, and discuss the implications of these findings
Adv Alcohol Subst Abuse 1987 ;7(1):29-37

Jonas JM; Gold MS
Naltrexone reverses bulimic symptoms
Lancet 1986 Apr 5 ;1(8484):807

Jonas JM; Gold MS
Treatment of antidepressant-resistant bulimia with naltrexone
Ten individuals with antidepressant-resistant bulimia were treated with the long-acting opiate antagonist naltrexone. Seven of the ten experienced at least a 75 percent reduction of their bulimic symptoms, and have maintained their improvement on three to five month follow-up. These preliminary data suggest that naltrexone may be of use in bulimia unresponsive to standard antidepressant therapy, and may provide insight into the role of endogenous opioids in the etiology of eating disorders
Int J Psychiatry Med 1986 ;16(4):305-309

Sternbach HA; Annitto W; Pottash AL; Gold MS
Anorexic effects of naltrexone in man
Lancet 1982 Feb 13 ;1(8268):388-389



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Alexander DeLuca, M.D., FASAM.

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Originally posted:  1/24/2003

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