Naltrexone use for self-injurious behavior in patients with developmental disabilities

Abstract

Self-injurious behavior (SIB) is a serious problem seen in individuals with developmental disabilities (DD). Evidence-based options for the treatment of SIB in patients with DD are limited and no medication is approved for this indication. Non-pharmacotherapeutic options including environmental change and behavioral therapy are generally recommended for use as first line therapy. However, these options are sometimes inadequate. Despite lack of strong evidence, a variety of medications are used for SIB in DD. These include: antipsychotics (typical and atypical), antiepileptic drugs (e.g. divalproex, carbamazepine, etc.), lithium, and antidepressants (particularly selective serotonin reuptake inhibitors). First line agents include atypical antipsychotics (e.g. risperidone, olanzapine) and mood stabilizers (e.g. divalproex, carbamazepine). However, if a patient fails to respond to these agents or has contraindications to these options, other agents may occasionally be utilized. One such agent is the opioid antagonist naltrexone. Using naltrexone for the treatment of SIB comes from the theory that SIB is influenced by the release of endogenous opioids. Therefore, blocking the effects of these opioids could attenuate these behaviors. This article briefly summarizes the evidence for safety and efficacy of naltrexone for SIB in DD.