are claimed to be involved in the therapeutic effects of low-dose naltrexone. Pharmacokinetics The absorption of naltrexone with oral administration is rapid and nearly complete (96%). The bioavailability of naltrexone with oral administration is 5 to 60% due to extensive first-pass metabolism. Peak concentrations of naltrexone are 19 to 44 μg/L after a single 100 mg oral dose and time to peak concentrations of naltrexone and 6β-naltrexol (metabolite) is within 1 hour. Linear increases in circulating naltrexone and 6β-naltrexol concentrations occur over an oral dose range of 50 to 200 mg. Naltrexone does not appear to be accumulated with repeated once-daily oral administration and there is no change in time to peak concentrations with repeated administration. The plasma protein binding of naltrexone is about 20% over a naltrexone concentration range of 0.1 to 500 μg/L. Its apparent volume of distribution at 100 mg orally is 16.1 L/kg after a single dose and 14.2 L/kg with repeated doses. Naltrexone is metabolized in the liver mainly by dihydrodiol dehydrogenases into 6β-naltrexol (6β-hydroxynaltrexone). Levels of 6β-naltrexol are 10- to 30-fold higher than those of naltrexone with oral administration due to extensive first-pass metabolism. Conversely, 6β-naltrexol exposure is only about 2-fold higher than that of naltrexone with intramuscular injection of naltrexone in microspheres (brand name Vivitrol). 6β-Naltrexol is an opioid receptor antagonist similarly to naltrexone and shows a comparable binding profile to the opioid receptors. However, 6β-naltrexol is peripherally selective and crosses into the brain much less readily than does naltrexone. In any case, 6β-naltrexol does still show some central activity and may contribute significantly to the central actions of oral naltrexone. Other metabolites of naltrexone include 2-hydroxy-3-methoxy-6β-naltrexol and 2-hydroxy-3-methoxynaltrexone. Following their formation, the metabolites of naltrexone are further metabolized by conjugation with glucuronic acid to form glucuronides. Naltrexone is not metabolized by the cytochrome P450 system and has low potential for drug interactions. The elimination of naltrexone is biexponential and rapid over the first 24 hours followed by a third extremely slow decline after 24 hours. The fast elimination half-lives of naltrexone and its metabolite 6β-naltrexol are about 4 hours and 13 hours, respectively. In Contrave oral tablets, which also contain bupropion and are described as extended-release, the half-life of naltrexone is 5 hours. The slow terminal-phase elimination half-life of naltrexone is approximately 96 hours. As microspheres of naltrexone by intramuscular injection (Vivitrol), the elimination half-lives of naltrexone and 6β-naltrexol are both 5