2 The technology
2.1 Nalmefene (Selincro, Lundbeck) is an opioid receptor modulator, which exhibits antagonist activity at the mu and delta opioid receptors, and partial agonist activity at the kappa opioid receptors. 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, according to the World Health Organization's drinking risk levels.
2.2 The marketing authorisation also states that 'nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption. It should only be started in patients who continue to have a high drinking risk level 2 weeks after initial assessment'.
2.3 The summary of product characteristics lists the following adverse reactions for nalmefene: nausea, dizziness, insomnia and headaches. For full details of adverse reactions and contraindications, see the summary of product characteristics.
2.4 Nalmefene is available as an 18 mg film‑coated tablet and is priced at £42.42 for a pack of 14 tablets or £84.84 for a packet of 28 tablets (excluding VAT; 'British national formulary' [BNF], online April 2014). It is taken orally at a maximum dose of 1 tablet daily on an 'as‑needed' basis. Costs may vary in different settings because of negotiated procurement discounts.