Naltrexone Extended Starter Pack — The Sinclair Method with Gentle 4.5mg to 25mg Titration and Extended Supply for Step-Up Flexibility
This is a specialist supply — the Naltrexone Extended Starter Pack is our most popular starting option for adults exploring The Sinclair Method (TSM) for alcohol use disorder, or receiving naltrexone treatment for other forms of pharmacological addiction under appropriate clinical assessment. So the pack provides the same gentle 4.5mg to 25mg titration approach as our standard Starter Pack — but with double the maintenance supply, giving 8-12 weeks of treatment time rather than 4-8. Furthermore, this extended supply matches the realistic timeline for The Sinclair Method to genuinely start working through pharmacological extinction. Each pack contains 30 x 4.5mg capsules and 60 x 25mg capsules, providing meaningful treatment duration for assessment of response. However, the Extended Pack also provides flexibility — if 25mg proves insufficient, there’s supply available to support the transition toward 50mg dosing without reordering. Above all, this pack represents the middle ground between initial trial and long-term commitment, and remains our most popular starting choice. Available at Courier Pharmacy after comprehensive assessment. £189 with full online assessment, no subscription, free delivery.
At Courier Pharmacy, we believe in treatment that fits the person, but only where it’s honest, safe, and consented to.
This page covers what the Extended Starter Pack is, why 8-12 weeks of supply matches the realistic Sinclair Method timeline, how the pack supports 50mg step-up if needed, who the pack may suit and who it doesn’t, how it compares to the standard Starter Pack and other approaches, and the practical points that matter. Above all, we cover the safeguarding considerations that make this treatment appropriate for some adults with alcohol use disorder but not others.
The assessment gateway — please read first
Before going further, we want to be straight with you about how naltrexone supply works at Courier Pharmacy:
First of all, naltrexone treatment for alcohol use disorder requires proper clinical assessment. In fact, this isn’t a straightforward retail purchase because several safety considerations need checking before supply. So our full online assessment is genuinely important, not paperwork.
The assessment covers several critical areas:
- Alcohol use pattern — frequency, quantity, duration, any dependence features
- Severity assessment — including screening for severe alcohol dependence that would need medically-supervised detoxification first
- Opioid use — any current or recent opioid use (prescription or otherwise) is an absolute contraindication that risks precipitated withdrawal
- Liver function history — pre-existing liver disease affects treatment approach
- Mental health context — active depression, suicidal ideation, or unstable mental health needs different care
- Comprehensive medication review — potential interactions checked
- Support network — who else knows about your treatment journey
- Treatment goals — reduction versus abstinence, timescales, expectations
- Realistic expectations — what The Sinclair Method actually delivers
Second, some adults are not suitable for naltrexone supply through Courier Pharmacy. In particular:
- Adults with severe physical alcohol dependence who need medically-supervised detoxification
- Adults currently using opioid medications (prescription or otherwise)
- Adults who have used opioids in the past 7-10 days
- Adults with acute or chronic liver disease
- Adults with active suicidal ideation or unstable mental health crisis
- Adults where safer or more comprehensive support pathways would suit better
Third, if the assessment identifies you’re not suitable for the pack, we’ll signpost you to appropriate services. So this may include NHS alcohol services, private specialist addiction services, or GP-based support depending on your circumstances. Above all, this isn’t about turning people away — it’s about matching you with the right support for where you actually are.
If any of these points raise concerns, please talk to our prescriber before proceeding. After all, understanding what’s involved matters for informed choice.
Five key takeaways
- The Extended Starter Pack is our most popular starting option for adults beginning naltrexone treatment via The Sinclair Method (TSM). So it provides the same gentle 4.5mg titration as our standard pack, plus double the 25mg maintenance supply for 8-12 weeks of treatment time
- The 8-12 week supply duration genuinely matches the realistic Sinclair Method timeline. Furthermore, this timeframe allows meaningful assessment of your response before reordering, rather than reordering during the early adjustment phase when response isn’t yet clear
- The pack provides flexibility to increase to 50mg dose sooner if needed. As a result, if 25mg proves insufficient after your initial response assessment, the extra 25mg capsules support the transition (two 25mg capsules = 50mg equivalent) without needing a separate reorder
- The pack contains 30 x 4.5mg capsules for gentle 10-day build-up, plus 60 x 25mg capsules for extended maintenance phase. Includes full instructions, no subscription commitment, and free delivery. £189 represents good value versus reordering the Starter Pack
- Not suitable for severe physical alcohol dependence (which needs medically-supervised detoxification), current or recent opioid use (precipitated withdrawal risk), active or chronic liver disease, or acute mental health crisis. Prescriber assessment before supply is essential
Extended Starter Pack vs Starter Pack
Direct comparison with our shorter starter option:
- Both packs use the same gentle 4.5mg to 25mg titration approach
- Both packs include the same 30 x 4.5mg capsules for 10-day build-up
- Extended Pack includes 60 x 25mg capsules
- In contrast, Starter Pack includes 30 x 25mg capsules
- Extended Pack provides 8-12 weeks of supply
- Starter Pack provides 4-8 weeks of supply
- Extended Pack allows meaningful response assessment
- Starter Pack suits shorter trial or budget-conscious patients
- Extended Pack supports 50mg step-up flexibility
- Starter Pack requires reorder for 50mg step-up
- Extended Pack (£189) offers better value than reordering Starter Pack (£149) twice
- Extended Pack has become our most popular starting choice
Sinclair Method vs abstinence-only approaches
Different treatment philosophies:
- Sinclair Method: gradual reduction through pharmacological extinction
- In contrast, abstinence approaches (AA): immediate cessation and lifelong avoidance
- TSM allows continued drinking during treatment
- AA requires immediate stopping
- TSM works pharmacologically; AA works psychosocially
- TSM has strong evidence base for reduced drinking
- AA has strong evidence base for maintained abstinence
- Different approaches suit different people
- Some patients combine both approaches
- Choice depends on personal goals and preferences
Sinclair Method vs disulfiram (Antabuse)
Very different pharmacological approaches:
- Sinclair Method: naltrexone blocks alcohol’s rewarding effect
- In contrast, disulfiram: causes unpleasant reaction if you drink
- Naltrexone doesn’t make you unwell if you drink
- Disulfiram deliberately makes drinking uncomfortable
- Naltrexone works through extinction over time
- Disulfiram works through deterrence
- Naltrexone allows gradual behavioural change
- Disulfiram requires immediate abstinence
- Different treatment philosophies for different situations
Sinclair Method vs acamprosate
Alternative pharmacological approach:
- Sinclair Method: naltrexone for reducing consumption
- In contrast, acamprosate: for maintaining abstinence after detoxification
- Naltrexone works during drinking
- Acamprosate works after stopping
- Different clinical scenarios
- Sometimes combined in comprehensive treatment
- Both have NICE guidance support
Sinclair Method vs nalmefene
Two opioid antagonist options for the same approach:
- The Sinclair Method can be used with either naltrexone or nalmefene — both are opioid receptor antagonists
- Naltrexone is the original and most widely studied option for Sinclair Method use
- Nalmefene can also be used within the Sinclair Method framework, taken before drinking
- Both block alcohol’s rewarding effect through opioid receptor blockade
- Nalmefene has NICE guidance support for reducing alcohol consumption in the UK
- Naltrexone has the longer evidence base and broader international use
- Nalmefene has slightly different receptor binding (partial kappa agonist activity)
- Nalmefene is not metabolised by the liver — a significant advantage for patients with hepatic concerns
- Naltrexone is metabolised by the liver, making baseline liver function assessment more important
- So nalmefene may suit patients with pre-existing liver conditions where naltrexone would be problematic
- Tolerability profiles differ between individuals — some patients prefer one over the other
- Nalmefene is typically dosed 1-2 hours before drinking rather than the standard 1 hour for naltrexone
- Choice depends on individual response, tolerability, hepatic status, and prescriber preference
- Our Sinclair Method service currently uses naltrexone (with option to discuss nalmefene if clinically indicated)
Extended Starter Pack vs standard 50mg naltrexone approach
Different starting philosophies:
- Extended Starter Pack: gentle 4.5mg build-up to 25mg maintenance
- In contrast, standard: 25mg or 50mg from day 1
- Extended Pack significantly reduces early side effects
- Standard approach delivers therapeutic dose faster
- Extended Pack improves treatment continuation
- Standard approach works well for tolerant patients
- Extended Pack suits sensitive patients or side-effect concerns
- Extended Pack supports natural transition to 50mg if needed
- Some patients respond fully at 25mg (Extended Pack suits)
- Some patients need 50mg (Extended Pack’s step-up flexibility helps)
Who this pack may suit well
The Extended Starter Pack may suit:
- Adults with mild-to-moderate alcohol use disorder
- Adults new to naltrexone treatment
- Adults concerned about medication side effects
- Adults who have stopped naltrexone previously due to side effects
- Adults wanting adequate time to properly assess TSM response
- Adults valuing dose flexibility during treatment
- Adults suspecting they may respond at 25mg (but wanting 50mg option)
- Older adults who benefit from lower starting doses
- Adults with lower body weight
- Adults with medication sensitivities
- Adults committed to consistent pre-drinking dosing
- Adults with realistic expectations about gradual improvement
- Adults with adequate support networks
- Adults preferring one meaningful supply over multiple reorders
- Adults wanting good value on entry-tier treatment
Who might suit other options better
Other options may suit better for:
- Adults with severe physical alcohol dependence needing medically-supervised detoxification
- Adults currently or recently using opioid medications
- Adults with acute or chronic liver disease
- Adults with abnormal baseline liver function
- Adults in active mental health crisis
- Adults with active suicidal ideation
- Adults wanting immediate abstinence approach (disulfiram or AA)
- Adults who won’t complete comprehensive assessment
- Adults unable to commit to consistent dosing before drinking
- Adults preferring purely psychosocial approaches
- Adults with known naltrexone allergy or previous serious reaction
- Adults pregnant or planning pregnancy
- Breastfeeding mothers
- Adults under 18
- Adults preferring shorter trial period (Starter Pack may suit better)
Courier Pharmacy supply — the full pathway
This pack is supplied within a comprehensive clinical framework. So the supply pathway involves several sequential steps:
Step 1: Full online assessment
Complete the naltrexone consultation on courierpharmacy.co.uk. This covers:
- Alcohol use pattern assessment (frequency, quantity, duration)
- AUDIT-C or similar screening tool
- Signs of physical dependence
- Previous withdrawal experiences
- Any current or recent opioid use (prescription or otherwise)
- Liver function history and any known liver conditions
- Mental health status and stability
- Previous suicidal ideation
- Current medications comprehensive review
- Previous naltrexone or Sinclair Method experience
- Support network available to you
- Treatment goals (reduction vs abstinence)
- Expectations about timeline and outcomes
- Any pregnancy consideration
Step 2: Prescriber review
Your consultation goes to our UK-qualified prescriber, who assesses:
- Whether TSM via Extended Starter Pack is clinically appropriate for you
- Whether the assessment reveals any red flags
- Whether severe dependence warrants specialist referral instead
- Whether opioid use makes naltrexone contraindicated
- Whether liver assessment is needed before supply
- Whether the gentle titration approach suits your situation
- Whether the Extended Pack duration fits your circumstances
- Whether shorter Starter Pack or longer Maintenance Pack would suit better
- Whether alternative treatment approaches would fit better
- Whether specialist services would suit better
Step 3: Prescription and dispensing
If the prescriber judges the Extended Starter Pack is appropriate:
- Prescription issued for naltrexone at both strengths
- Compounded to specialist quality standards
- Dispensed from GPhC-regulated pharmacy premises
- Full written instructions included
Step 4: Discreet delivery and ongoing support
Your order arrives in plain packaging with clear supporting materials:
- Full day-by-day titration guide for the first 10 days
- Sinclair Method dosing protocol for maintenance phase
- Guidance on response assessment over 8-12 weeks
- Instructions for 50mg step-up if appropriate
- Red flag symptoms to watch for
- When and how to contact us for support
- Free prescriber support available throughout treatment
Signposting when the pack isn’t right
If the assessment identifies the Extended Starter Pack isn’t right for you, we signpost appropriately:
- Severe dependence — NHS alcohol services or medically-supervised detoxification
- Complex mental health needs — GP referral and specialist mental health support
- Opioid use situation — specialist addiction services
- Liver disease — hepatology review before considering treatment
- Crisis situations — Samaritans (116 123), NHS 111, A&E as appropriate
- This isn’t about turning people away — it’s about matching you with the right support
Why choose Courier Pharmacy for naltrexone treatment
At Courier Pharmacy, our approach starts with a simple idea: treatment should fit the person, not force the person to fit the system.
Dr Ada Jex-Cori
Our service is shaped by the philosophy of Dr Ada Jex-Cori, our brand pharmacist.
Dr Ada represents the spirit of the pharmacy: evidence-led, community-rooted, and willing to challenge the one-size-fits-all approach to medicine. She is named in honour of three pioneering women in science: Ada Lovelace, the mathematician and visionary; Sophia Jex-Blake, the first female doctor in the UK who fought the medical establishment; and Gerty Cori, the biochemist and Nobel Prize winner.
In our fictional world of Ethrewell, Dr Ada fights against pharma’s standardised approach to medicine. In the real world, she represents what we stand for. Her view is straightforward: you are not broken. The system is. And we are here to change that.
Alcohol use disorder deserves proper clinical framing
This is a sensitive clinical area. Courier Pharmacy is different. So we recognise that:
- Problematic alcohol use exists on a spectrum, not as a binary state
- Many adults want reduction rather than immediate abstinence
- Traditional pathways often feel inaccessible or misaligned with reality
- Evidence-based pharmacological approaches like TSM offer genuine alternatives
- Proper clinical assessment protects patients from unsuitable treatment
- Signposting to specialist services when needed matters more than always saying yes
- Treatment works best alongside broader support
Honest framing about extended supply
Why 8-12 weeks matters clinically:
- Shorter supply periods create pressure to reorder during unclear response
- 8-12 weeks matches actual TSM response timeline
- Adequate treatment time supports informed continuation decisions
- Better than committing to long-term supply before assessing response
- Better than multiple small reorders during ongoing assessment
- Value-conscious approach to entry-tier treatment
Honest framing about dose flexibility
Why the step-up option matters:
- Some patients respond fully at 25mg
- Others need 50mg for adequate effect
- You can’t reliably predict individual response in advance
- Extended Pack supports either outcome without additional reordering
- Prescriber support guides step-up timing and appropriateness
- Two 25mg capsules together provide 50mg equivalent
Honest framing about limits
What we don’t offer:
- We don’t offer treatment for severe physical dependence
- We don’t offer treatment for opioid-dependent patients
- We don’t offer treatment for acute mental health crisis
- We don’t replace comprehensive addiction services
- We don’t offer inpatient or intensive outpatient care
- For any of these needs, specialist services fit better
Alcohol use disorder and the bigger picture
Problematic drinking rarely sits in isolation. So our prescriber can discuss:
- Comprehensive assessment of drinking patterns and impact
- Underlying factors that drive drinking
- Mental health considerations
- Sleep and drinking patterns
- Relationship and social factors
- Work and stress considerations
- Physical health impact of drinking
- Liver function assessment
- Comprehensive support options
- When and how to combine approaches
- Long-term management strategy
- Relapse prevention thinking
Sometimes the drinking is one part of a wider picture worth talking through.
Prescriber support throughout treatment
Our team is here to discuss:
- Whether the Extended Starter Pack fits your specific situation
- Whether shorter Starter Pack or longer Maintenance Pack would suit better
- Whether standard 50mg approach would suit better from day one
- Whether specialist services would fit better
- Managing side effects during titration
- Practical questions about Sinclair Method protocol
- Tracking progress meaningfully over 8-12 weeks
- Assessing response and considering step-up decisions
- When and how to move to 50mg dosing
- Comprehensive support alongside pharmacological treatment
- Managing setbacks realistically
- Long-term treatment considerations after Extended Pack completion
Trust earned, not claimed
We are GPhC-regulated, and our content is grounded in the licensed naltrexone Summary of Product Characteristics, NICE guidance on alcohol use disorders (CG115), NICE clinical knowledge summaries on alcohol problem drinking, evidence from major clinical trials on The Sinclair Method, published research on pharmacological extinction, MHRA guidance on medicine supply, and the real experience of patients approaching alcohol use disorder through pharmacological approaches.
If the Extended Starter Pack isn’t the right answer for your situation, we’ll tell you honestly. After all, getting the right approach matters more than fulfilling a request.
More than a prescription: our community
Healthcare shouldn’t only happen when you’re paying for it.
Every fortnight we run free drop-in talks and clinics at Insomnia, Derby, from 10am to 12pm. So we show up, even when it’s free.
Bring a question, bring a friend, bring a stack of bewildering letters from another clinic. We’ll sit with you.
We cover weight management, GLP-1 therapy, MCAS, menopause, women’s health, men’s health, chronic pain, digestive health, allergies, asthma, sleep, migraine, skincare, acne, hair loss, alcohol use disorder support, and whatever else people bring through the door. No appointment. No cost. No pressure. Just real support and treatment that fits.
Active ingredients
Each capsule contains
- Naltrexone hydrochloride (as active ingredient) — at either 4.5mg or 25mg strength
- Microcrystalline cellulose (as filler)
- Standard capsule excipients supporting stability
Capsule composition
- Vegetarian HPMC capsules (Hydroxypropyl methylcellulose)
- Suitable for vegetarian and vegan patients
- Free from gelatin (no animal-derived components)
- Free from common allergens (nuts, dairy, gluten, soy)
- Halal and kosher suitable
Two capsule strengths in your pack
- 30 x low-dose capsules containing 4.5mg naltrexone hydrochloride — for the 10-day titration phase
- 60 x medium-dose capsules containing 25mg naltrexone hydrochloride — for the extended maintenance phase
Both capsule strengths use the same excipients. So the only difference is the naltrexone hydrochloride content. Furthermore, both use vegetarian HPMC capsule shells.
What's in the pack
30 x low-dose 4.5mg capsules
- Provide the gentle build-up phase over the first 10 days
- Typical use: 3 capsules per day to build gradual tolerance
- Allows your body to adjust to naltrexone gradually
- Significantly reduces early side effect burden
- Compounded to specialist quality standards
- This is a specialist dose not routinely available in standard packs
60 x medium-dose 25mg capsules
- Provide the extended maintenance treatment phase
- Take one capsule one hour before drinking alcohol (Sinclair Method protocol)
- Standard TSM maintenance dose for many patients
- Effective dose for those who respond at 25mg without needing 50mg
- Also supports 50mg dosing (two capsules) if step-up needed
- Compounded to specialist quality standards
- Around 8-12 weeks supply depending on drinking frequency
The 50mg step-up flexibility
- Two 25mg capsules taken together equal 50mg dose
- Allows transition to standard TSM dosing if 25mg proves insufficient
- At 50mg dosing, the pack provides approximately 4-6 weeks of supply
- Prescriber support available to discuss step-up decisions
- No need to reorder if dose adjustment becomes appropriate
Full instructions
- Clear day-by-day titration guide for the first 10 days
- Sinclair Method dosing instructions for the maintenance phase
- Guidance on assessing your response over 8-12 weeks
- Instructions for 50mg step-up if appropriate
- Symptom monitoring guidance
- When to contact us for support
- Red flag symptoms to watch for
No subscription commitment
- One-off purchase pattern
- No automatic re-orders
- You control when to reorder based on your progress
- Reflects our belief that treatment should fit your circumstances
Free delivery
- Discreet plain packaging
- Suitable for home or workplace delivery
- No mention of contents on packaging
Why this pack is our most popular option
The Extended Starter Pack has become our most popular starting choice for practical clinical reasons. In fact, the 8-12 week supply duration reflects genuine clinical experience about what patients actually need. Furthermore, the built-in flexibility for 50mg step-up addresses one of the most common practical questions patients face during early TSM treatment.
The realistic treatment timeline consideration
Why 8-12 weeks matches actual clinical need:
- The Sinclair Method genuinely takes months, not weeks, to work fully
- Days 1-10: titration phase, minimal drinking behaviour change
- Weeks 2-4: some patients notice early adjustment effects
- Weeks 4-8: patterns start emerging for many patients
- Weeks 8-12: response typically clearer and more meaningful
- So reordering at 4-8 weeks means reordering during unclear response period
- Whereas 8-12 weeks provides basis for informed continuation decisions
The dose flexibility consideration
Why the 50mg step-up option matters:
- Some patients respond fully at 25mg — no step-up needed
- Some patients need 50mg for adequate effect
- You can't reliably predict which category you'll fall into
- Response assessment guides the step-up decision
- Extended pack supports either outcome without additional ordering
- Prescriber support available to guide step-up timing
- Two 25mg capsules taken together provide 50mg equivalent
The value consideration
Why this represents good value:
- £189 provides double the maintenance supply vs Starter Pack (£149)
- So the additional 30 x 25mg capsules cost only £40 extra
- Reordering two Starter Packs would cost £298 vs Extended Pack £189
- Full assessment still included with the pack
- Delivery still free
- No subscription commitment — reorder only when needed
Who benefits most from choosing this pack
- Patients wanting adequate time to assess TSM response properly
- Patients preferring meaningful supply over multiple reorders
- Patients wanting flexibility around dose adjustment
- Patients who value good value on entry-tier treatment
- Patients who prefer to avoid frequent reordering hassle
- Patients wanting reduced administrative burden during treatment
What is the Extended Starter Pack for?
The Extended Starter Pack is designed for adults beginning naltrexone treatment for alcohol use disorder using The Sinclair Method (TSM) — an evidence-based pharmacological approach to reducing problematic alcohol use over time. Furthermore, it may suit adults receiving naltrexone treatment for other forms of pharmacological addiction under appropriate clinical assessment. So the pack fits the entry point of a genuine treatment journey but with realistic treatment duration built in from the start.
Why 'Extended' — the treatment duration philosophy
The extended supply matches clinical reality:
- The Sinclair Method works through pharmacological extinction over weeks to months
- First 10 days are gentle titration — minimal drinking behaviour change
- Weeks 2-4 show early adjustment — some patients notice reduced drinking pleasure
- Months 1-3 typically show meaningful consumption reduction
- Months 3-6 often represent the point of significant change
- So 4-8 weeks (Starter Pack duration) sits at the early end of realistic assessment
- 8-12 weeks (Extended Pack duration) allows genuinely meaningful response assessment
- This is why we call it our most popular option — it matches actual treatment reality
Why 'Starter' — the response assessment philosophy
Extended supply supports proper decision-making:
- You need enough treatment time to assess whether TSM works for you
- Early response varies significantly between patients
- Some patients need dose adjustment before finding their optimal level
- Others discover TSM isn't the right approach after adequate trial
- Extended Pack provides the trial period needed for informed continuation decisions
- Better than committing to long-term supply before knowing individual response
- Better than reordering multiple starter packs during ongoing assessment
Who might the Extended Starter Pack suit?
The pack may suit adults who:
- Have identified problematic alcohol use they want to address
- Are not severely physically dependent on alcohol
- Want a pharmacological approach alongside or instead of abstinence-only support
- Are motivated to reduce or eventually stop drinking
- Want adequate treatment time to properly assess Sinclair Method response
- Value the flexibility to step up to 50mg dosing if 25mg proves insufficient
- Prefer meaningful supply over multiple small reorders
- Are not using opioid medications currently or recently
- Have normal or reasonable liver function
- Are mentally stable enough to engage with treatment
- Have realistic expectations about gradual improvement over weeks and months
- Are willing to complete the assessment properly
- Want a gentler introduction to naltrexone than the standard 50mg approach
- Are committed to consistent pre-drinking dosing for the extended treatment period
What the Extended Starter Pack may help with
Based on naltrexone pharmacology and Sinclair Method evidence:
- Meaningful reduction in alcohol consumption over the 8-12 week supply period
- Reduction in the rewarding feeling from drinking
- Reduction in cravings over time
- Reduction in binge drinking episodes
- Support for gradual behavioural change through pharmacological extinction
- Better control over drinking situations
- Reduction in health harms from continued heavy drinking
- Improvement in liver function markers in many patients (as drinking reduces)
- Better sleep, mood, and general wellbeing as drinking reduces
- Adequate treatment time to properly assess whether TSM works for you
- Flexibility to explore 50mg dosing if 25mg proves insufficient
However, an important honesty point: TSM doesn't work for everyone. In fact, response rates vary — some patients experience meaningful reduction while others find limited benefit. Furthermore, the process is gradual not immediate. Additionally, results depend on consistent naltrexone use before drinking (missing doses undermines the extinction process). So realistic expectations matter genuinely.
What the Extended Starter Pack doesn't claim to do
Honest framing matters:
- It doesn't make you unable to drink (unlike disulfiram which causes reactions)
- It doesn't work immediately — the extinction process takes weeks to months
- It doesn't work if you don't take it before drinking (this is essential)
- It doesn't replace comprehensive addiction support where that's needed
- It doesn't help everyone equally — response varies significantly between individuals
- It doesn't treat severe physical alcohol dependence (needs medically-supervised detoxification)
- It doesn't work for people currently or recently using opioids
- It doesn't replace therapy, counselling, or support groups where those are helpful
- It doesn't address underlying reasons for drinking (mental health, trauma, life stress)
- It isn't a substitute for engaging with your GP if you're struggling
- It doesn't guarantee 50mg step-up will suit you if 25mg doesn't work adequately
Warnings and precautions
Naltrexone has specific safety considerations that make the assessment gateway genuinely important.
Don't take the Extended Starter Pack if you
- Are currently using any opioid medication (prescription or otherwise)
- Have used opioids in the past 7-10 days
- Have acute hepatitis or liver failure
- Have severe hepatic impairment
- Have hypersensitivity to naltrexone
- Are pregnant or planning pregnancy
- Are breastfeeding
- Are under 18
- Are in acute alcohol withdrawal
- Need medically-supervised detoxification for severe dependence
The critical opioid consideration
This is the most important safety point:
- Naltrexone blocks opioid receptors
- If you have opioids in your system, naltrexone triggers acute withdrawal
- This is called precipitated withdrawal
- Symptoms include severe nausea, vomiting, diarrhoea, abdominal cramps, sweating, agitation
- Precipitated withdrawal can be genuinely dangerous
- This includes prescription opioid pain medications (codeine, tramadol, morphine, oxycodone, fentanyl, and others)
- This includes any illicit opioid use
- Minimum 7-10 day opioid-free period required before starting naltrexone
- Longer periods needed for long-acting opioids (methadone requires 10-14 days)
- Blood or urine testing may be needed to confirm opioid-free status
- Also affects emergency pain relief — carry a medical card noting naltrexone use
The severe alcohol dependence consideration
Not everyone with alcohol problems should use TSM:
- Severe physical alcohol dependence carries withdrawal risks when consumption reduces
- Alcohol withdrawal can be genuinely dangerous — including seizures, delirium tremens, cardiovascular effects
- Adults with severe dependence need medically-supervised detoxification first
- This isn't a Courier Pharmacy service — needs specialist alcohol services
- Signs of severe dependence: morning drinking, hand tremors, sweats, needing alcohol to function, previous withdrawal episodes
- Our assessment identifies these signs and signposts appropriately
The mental health consideration
Important safeguarding point:
- Naltrexone has been associated with mood changes and depression
- Not for use during active mental health crisis
- Active suicidal ideation is a contraindication
- Existing depression should be stable and managed before starting
- Report any new mood changes during treatment
- Comprehensive mental health support may be needed alongside
The liver function consideration
Important for safe supply:
- Naltrexone is metabolised by the liver
- Acute or chronic liver disease affects processing
- Very high doses can cause hepatotoxicity (much higher than treatment doses)
- Regular liver function testing recommended
- Alcohol reduction actually improves liver function in most patients
- Assessment identifies liver risk factors
The step-up decision consideration
If considering 50mg step-up:
- Discuss with prescriber before starting 50mg dosing
- Assess response at 25mg over adequate time (8-10 weeks typically)
- Consider whether adherence has been consistent
- Consider whether other factors affect response
- Higher dose means slightly higher side effect potential
- Step-up isn't automatic — needs clinical judgement
Use with care if you
- Have moderate hepatic impairment
- Have renal impairment
- Are on medications with potential interactions
- Have any history of mood or mental health difficulties
- Are elderly (dose adjustment may be needed)
- Have any chronic medical conditions
Emergency medical situations
Important during naltrexone treatment:
- Naltrexone blocks opioid effects — including emergency pain relief
- Emergency situations needing opioid pain relief require higher doses to overcome blockade
- Carry a medical card noting current naltrexone treatment
- Inform any healthcare provider you're taking naltrexone
- Anaesthesia and surgery need advance discussion with your team
- Pain management strategies may need adjustment
Pregnancy and breastfeeding
- Not for use during pregnancy
- Effective contraception during use if of childbearing potential
- Not for use during breastfeeding — passes into breast milk
- Treatment can be deferred until after pregnancy and breastfeeding
Driving and machinery
Can affect driving initially:
- May cause dizziness, drowsiness, or fatigue initially
- Don't drive if experiencing these symptoms
- Effects usually settle as treatment continues
When to seek urgent medical help
- Signs of precipitated opioid withdrawal (severe nausea, vomiting, agitation)
- Signs of severe allergic reaction (facial swelling, breathing difficulty)
- Signs of hepatitis (jaundice, dark urine, abdominal pain)
- Severe or persistent mood changes
- Any suicidal thoughts
- Signs of alcohol withdrawal (tremor, sweats, hallucinations, seizures) — call 999
- Any concerning symptoms
Frequently asked questions
Why is this pack extended?
Realistic treatment duration:
- Contains 60 x 25mg capsules vs 30 in the standard Starter Pack
- Provides 8-12 weeks of supply vs 4-8 weeks
- Matches the realistic TSM response timeline
- Allows meaningful assessment of your response
- Reduces pressure to reorder during unclear early response
Why is this your most popular option?
Because it matches clinical reality:
- The Sinclair Method takes months to work fully
- 8-12 weeks provides adequate assessment period
- Reduces need for multiple small reorders
- Better value than reordering Starter Pack twice
- Built-in flexibility for potential 50mg step-up
- Suits most first-time TSM users
How does the 50mg step-up work?
Straightforward using existing capsules:
- Take two 25mg capsules together instead of one
- Two capsules together provide 50mg equivalent
- Same one-hour before drinking timing
- Discuss with prescriber before starting 50mg dosing
- Extended Pack supply supports approximately 4-6 weeks at 50mg
When should I consider stepping up to 50mg?
Prescriber guides this decision:
- Assess response over adequate time (8-10 weeks typical)
- Consider whether 25mg has produced meaningful change
- Check adherence has been consistent
- Consider whether other factors affect response
- Prescriber support available to discuss
- Not everyone needs step-up
Should I choose this or the standard Starter Pack?
Depends on your preferences:
- Extended Pack better if you want adequate assessment time
- Extended Pack better if you want 50mg flexibility
- Extended Pack better value if you're likely to reorder anyway
- Starter Pack better if you're unsure about commitment
- Starter Pack better if budget is tighter initially
- Most patients ultimately benefit from Extended Pack duration
What is The Sinclair Method exactly?
An evidence-based pharmacological approach:
- Uses naltrexone to gradually reduce alcohol's rewarding effect
- Take one hour before drinking, on drinking days only
- Works through pharmacological extinction over weeks to months
- Doesn't require immediate abstinence
- Endorsed by American Society of Addiction Medicine
- Growing recognition in UK addiction medicine
Do I need to stop drinking to use this?
No — that's the point of TSM:
- Sinclair Method deliberately involves continued drinking
- Pharmacological extinction requires drinking with naltrexone present
- Consumption typically reduces over weeks to months
- Different from immediate-abstinence approaches
- Some patients eventually reach abstinence, others achieve controlled drinking
How long until I see results?
Weeks to months, not days:
- Days 1-10: titration phase, minimal drinking behaviour change
- Weeks 2-4: some patients notice reduced drinking pleasure
- Weeks 4-8: patterns start emerging
- Weeks 8-12: response typically clearer
- Individual response varies significantly
What if I'm on opioid pain medication?
Naltrexone isn't suitable:
- Precipitated withdrawal risk with any opioid exposure
- Includes codeine, tramadol, morphine, oxycodone, others
- Includes past 7-10 days of opioid use
- Discuss pain management with your GP first
- Alternative approaches for AUD may fit better
What if I need emergency pain relief?
Important safety point:
- Naltrexone blocks opioid effects
- Emergency opioid pain relief needs higher doses to overcome blockade
- Carry a medical card noting naltrexone use
- Tell any healthcare provider
- Non-opioid pain management (paracetamol, NSAIDs) work normally
Can I drink alcohol without taking naltrexone?
Physically yes, but it undermines TSM:
- You can drink without naltrexone — no harmful reaction (unlike disulfiram)
- However, drinking without naltrexone reinforces the reward pathway
- This undermines the extinction process
- Try to always dose before planned drinking
- Occasional missed doses won't ruin treatment but consistency matters
Should I have therapy alongside?
Often helpful:
- Cognitive behavioural therapy (CBT) evidence-based
- Motivational interviewing helpful
- SMART Recovery aligns with TSM philosophy
- Counselling for underlying issues
- Peer support where accessible
- Combined approaches often work best
What happens after the Extended Pack finishes?
Depends on your response:
- If TSM working well at 25mg — reorder Extended Pack or move to Maintenance Pack
- If 50mg step-up needed — reorder Extended Pack for continued step-up assessment
- If TSM proving effective long-term — Maintenance Pack for ongoing supply
- If TSM not working adequately — discuss alternatives with prescriber
- Prescriber support guides continuation decisions
What does £189 include?
Full pack and support:
- 30 x 4.5mg capsules
- 60 x 25mg capsules
- Full online clinical assessment
- Prescriber review
- Full written instructions
- Free discreet delivery
- Ongoing prescriber support
- No subscription commitment
Is this available on the NHS?
Depends on your area:
- Naltrexone is licensed and available on NHS
- Availability through NHS varies by area
- Specialist alcohol services may prescribe
- Some GPs comfortable prescribing, others refer
- Private supply through Courier Pharmacy offers assessment and support
How do I order the Extended Starter Pack?
Complete the naltrexone consultation on courierpharmacy.co.uk. Our prescriber will review your alcohol use pattern, medical history, current medications (particularly checking for opioid exposure), mental health status, and treatment goals. So the assessment identifies whether the Extended Starter Pack genuinely fits your situation. Furthermore, if the pack isn't right, we'll signpost you to appropriate services. Your order arrives in plain discreet packaging with full instructions and ongoing prescriber support available throughout treatment.
Disclaimer: This page is for information only and isn't a substitute for personal medical advice. Naltrexone is a prescription-only medicine (POM) — the Naltrexone Extended Starter Pack contains 30 x 4.5mg and 60 x 25mg capsules compounded to specialist quality standards for The Sinclair Method treatment of alcohol use disorder, or other forms of pharmacological addiction under appropriate specialist assessment.
ABSOLUTELY CONTRAINDICATED in current or recent (past 7-10 days) opioid use of any kind — precipitated withdrawal risk can be genuinely dangerous. Also contraindicated in acute hepatitis or liver failure, severe hepatic impairment, hypersensitivity to naltrexone, pregnancy, breastfeeding, active mental health crisis, active suicidal ideation, acute alcohol withdrawal, severe physical alcohol dependence requiring medically-supervised detoxification, and under 18.
Adults with severe alcohol dependence should not attempt to reduce alcohol consumption without medical supervision — withdrawal can be dangerous including seizures, delirium tremens, and cardiovascular effects. Sinclair Method works gradually over weeks to months through pharmacological extinction — not immediately.
Consistent dosing one hour before drinking is essential. Missing doses undermines the extinction process. 50mg step-up decision should be discussed with prescriber before starting higher dose.
Adults with active suicidal thoughts should contact their GP, NHS 111, Samaritans (116 123), or emergency services (999) immediately — not attempt self-treatment through this pack. Signs of severe allergic reaction, hepatitis (jaundice, dark urine, abdominal pain), precipitated opioid withdrawal (severe nausea, vomiting, agitation), or alcohol withdrawal (tremor, sweats, hallucinations, seizures) require immediate medical attention.
Emergency pain management during naltrexone treatment requires specialist input — carry a medical card noting current naltrexone use. Anaesthesia and surgery need advance discussion with medical team. This treatment works best alongside comprehensive psychosocial support where indicated. Courier Pharmacy assessment identifies patients suitable for the pack and signposts those needing different services to appropriate specialist care. This isn't a replacement for comprehensive addiction services when those are needed.
How this content was created
Written by the Courier Pharmacy editorial team and reviewed by a GPhC-registered prescribing pharmacist.
The content is grounded in the licensed Naltrexone Summary of Product Characteristics from UK manufacturers, NICE guidance on the diagnosis, assessment and management of harmful drinking and alcohol dependence (CG115), NICE Clinical Knowledge Summaries on alcohol problem drinking, published research on The Sinclair Method and pharmacological extinction, the American Society of Addiction Medicine guidance on alcohol use disorder pharmacotherapy, MHRA guidance on medicinal product supply, and the real experience of patients approaching alcohol use disorder through pharmacological treatment pathways.
References
- Electronic Medicines Compendium (emc) Naltrexone Summary of Product Characteristics. https://www.medicines.org.uk/emc/
- NICE Clinical Guideline CG115 — Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. https://www.nice.org.uk/guidance/cg115
- NICE Clinical Knowledge Summary — Alcohol problem drinking. https://cks.nice.org.uk/topics/alcohol-problem-drinking/
- American Society of Addiction Medicine — The Sinclair Method structured naltrexone protocol to reduce alcohol use. https://www.asam.org/
- Courier Pharmacy (2026) The Sinclair Method: Blocking Endorphin-Driven Reward. Courier Pharmacy. Available at: https://courierpharmacy.co.uk/the-sinclair-method-blocking-endorphin-driven-reward/ (Accessed: 28 July 2026).
