Indication

Reduction of alcohol consumption in adult patients who have a high drinking risk level without physical withdrawal risk

RAG rating

Red

Document type

Decision document

Place

East and North Hertfordshire
South and West Hertfordshire

Output type

Pharmacy / Prescribing

Nalmefene

HERTFORDSHIRE AND WEST ESSEX AREA PRESCRIBING COMMITTEE (HWE APC)

Nalmefene for reducing alcohol consumption in people with alcohol dependence

RED

Recommended for restricted prescribing by specialist only

Not recommended for primary care prescribing

Name generic (trade) Nalmefene

What it is Opioid receptor modulator

Indication Reduction of alcohol consumption in adult patients who have a high drinking risk level without physical withdrawal risk

Date decision last revised February 2015 (update of January 2014 HMMC decision)

Decision status Interim (until commissioned service is reviewed by local authority)

NICE / SMC Guidance NICE TA 325 - recommended

Recommendation:

NOT RECOMMENDED for prescribing in primary care by GPs. GPs are advised to refer potential nalmefene recipients to the Drug and Alcohol Service provided locally by Spectrum1.

RECOMMENDED for prescribing by the local authority commissioned specialist drug and alcohol service (Spectrum1) in conjunction with psychosocial support.

Commissioning responsibility for drug and alcohol services lies with the local authority.

GPs are advised not to prescribe this treatment because:

• It is important that service users access nalmefene in conjunction with psychosocial support and there is a risk that service users will not receive both treatment modalities if nalmefene is provided in primary care without a clear treatment pathway including appropriate psychosocial support.
• GP providers have not been formally commissioned to provide this service and therefore are not funded to provide it at this time.

NICE recommendation2:

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.

References:

1. Spectrum Drug and Alcohol Recovery Services https://www.changegrowlive.org/spectrum-hertfordshire-drug-alcohol-services

2. NICE TAG 325 – Nalmefene for reducing alcohol consumption in people with alcohol dependence, November 2014 http://guidance.nice.org.uk/TA325

Version number

1.1

Developed by

Hertfordshire Pharmacy and Medicines Optimisation Teams East and North Herts CCG and Herts Valleys CCG

Approved by

HMMC

Date approved / updated

February 2015 (update of January 2014 HMMC decision)

Review date

This recommendation is based upon the evidence available at the time of publication. The recommendation will be reviewed upon request in the light of new evidence becoming available

Superseded version

1.0 adopted as part of HWE APC harmonisation work