Updated on February 6, 2024
4 min read

Naltrexone for Alcoholism and Alcohol Use Disorder

What is Naltrexone?

Naltrexone is an opioid antagonist medication that treats opioid and alcohol use disorders (AUDs). 

It stops the euphoric effects of opioids (like opium, heroin, morphine, and oxycodone) by blocking opioid receptors in the brain.1, 2, 3

While naltrexone was initially only used for opioid addiction treatment, it was later found to have a similar effect against alcohol addiction. The U.S. Food and Drug Administration (FDA) approved naltrexone for alcohol addiction treatment in 1994.4 

Disulfiram, acamprosate, and naltrexone are currently the only FDA-approved medications for treating alcohol use disorder.1

Naltrexone:1, 3 

  • Decreases a person’s craving to drink alcohol
  • May help a person remain sober by blocking the ‘good’ feelings associated with drinking
  • Doesn’t prevent a person from getting drunk
  • Doesn’t treat alcohol withdrawal symptoms
  • Isn’t addictive
  • Won’t cause withdrawal symptoms if people stop using naltrexone

How Naltrexone Works

Naltrexone suppresses cravings for both opioids and alcohol. It reduces the “reward” feeling associated with opioid and alcohol use. 

As a result, people gradually lose the desire to drink. Eventually, they may quit consuming alcohol altogether.5, 6

Naltrexone works differently from disulfiram and acamprosate, the other two FDA-approved drugs for AUD. 

Unlike disulfiram, naltrexone does not make people feel sick when they drink. And unlike acamprosate, naltrexone doesn’t reduce long-lasting alcohol withdrawal symptoms.6, 7

What Happens if You Drink Alcohol While on Naltrexone?

You are not required to stop drinking with naltrexone. 

People who drink alcohol while taking naltrexone may eventually feel reduced alcohol cravings. This may lead them to reduced alcohol intake or abstinence.1, 2, 4

Naltrexone won’t prevent people from getting drunk. They will still feel the acute effects of alcohol consumption (like intoxication, impaired judgment, and loss of coordination).1, 2

Naltrexone also won’t reduce health risks associated with long-term alcohol use (like liver, cardiovascular, and kidney damage).1, 2

People may experience alcohol withdrawal if they suddenly quit drinking while taking naltrexone. Naltrexone doesn’t have any effects against seizures and other symptoms.1, 3

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When is Naltrexone Used in Alcohol Treatment?

A medical professional will determine if naltrexone is right for you. Naltrexone is relatively safe when it comes to side effects. 

Consult your doctor before starting naltrexone treatment. Naltrexone may not be right for you if you:3, 5

  • Take opioid medications for pain, cough, colds, or diarrhea
  • Are dependent on opioids
  • Are currently on a detox process
  • Are currently experiencing withdrawal symptoms
  • Have liver problems
  • Have hemophilia and/or other bleeding problems
  • Use illegal drugs
  • Are pregnant, planning to become pregnant, or breastfeeding
  • Currently receive medical treatment for OUD and/or AUD
  • Are allergic to naltrexone

Naltrexone is also not recommended for people under 18 years old or people with health conditions that may be aggravated by naltrexone.3

Is Naltrexone Effective?

Naltrexone isn’t a complete cure for alcohol addiction. It’s usually more effective when combined with other treatments.1, 6

Compared to behavioral therapy alone, combining naltrexone and counseling reduced drinking and increased abstinence significantly.8

In a study of 104 alcohol-dependent subjects, naltrexone showed better results than a placebo. Subjects who took naltrexone showed:5

  • Improved abstention rates (51% vs. 23%)
  • Lower relapse rates (31% vs. 60%)
  • Fewer drinking days

Naltrexone is typically more effective if it’s taken before drinking, rather than taking it and abstaining from alcohol. This treatment approach is called The Sinclair Method (TSM).4

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How Quickly Does Naltrexone Work?

Naltrexone’s effects may take a few months to kick in for some people. Other people may feel an immediate impact. 

Naltrexone treatment usually only lasts for 3 to 4 months. The doctor and patient will decide the exact duration.

This drug is not intended for long-term use. It’s usually not prescribed past the first year of alcohol addiction treatment.3, 6

What are the Different Types of Naltrexone?

Here are three different types of naltrexone:

1. Oral Naltrexone

This is the most commonly prescribed form. It’s often used in inpatient alcohol rehab. 

Naltrexone pills or tablets are sold under the brand names ReVia and Depade. The typical dosage is 50 mg once a day.2, 3

2. Intramuscular Naltrexone 

This is the injectable, extended-release form. It’s used for treating both alcohol and opioid use disorders (OUDs). 

Naltrexone injectable is sold under the brand name Vivitrol. It’s usually administered at 380 mg once per month.2, 3

3. Naltrexone Implant

This is the newest form of naltrexone that is inserted under the skin. It slowly releases the drug for 10 to 12 weeks.9

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What are Some Common Side Effects of Naltrexone?

Naltrexone has relatively few and mild side effects, making it a popular treatment choice for AUD and/or OUD. It can still cause severe side effects that require careful monitoring. 

Common side effects include:1, 2, 3, 5

  • Nausea
  • Vomiting
  • Decreased appetite
  • Diarrhea
  • Headache
  • Toothache
  • Muscle cramps
  • Joint or muscle pain
  • Fatigue
  • Sleepiness
  • Insomnia
  • Anxiety 
  • Nervousness
  • Dizziness

Rare and severe side effects include:1, 3

  • Severe allergic reactions
  • Trouble breathing
  • Chest pain
  • Swelling of the face, eyes, mouth, or tongue
  • Depression
  • Liver damage
  • Stomach pain that lasts for days
  • Tissue death
  • Skin rash

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Updated on February 6, 2024
9 sources cited
Updated on February 6, 2024
  1. 5. Answers to Frequently Asked Medication Questions.National Institute on Alcohol Abuse and Alcoholism (NIAAA). 
  2. “What is Naltrexone?” University of Arkansas for Medical Sciences Psychiatric Research Institute. https://psychiatry.uams.edu/clinical-care/cast/what-is-naltrexone/.
  3. Naltrexone.Substance Abuse and Mental Health Services Administration (SAMHSA). March 4, 2022. 
  4. Sinclair, John David. “Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism.” Alcohol and Alcoholism vol. 36, 1 : 2-10.
  5. REVIA®.Duramed Pharmaceuticals, Inc. October 2013.  
  6. Naltrexone for Alcoholism.Am Fam Physician vol. 61, 6 :1891. 
  7. Treatment Approaches for Drug Addiction.National Institute on Drug Abuse (NIDA). January 2019. 
  8. Pettinati, Helen M et al. “The COMBINE Study-: An Overview of the Largest Pharmacotherapy Study to Date for Treating Alcohol Dependence.Psychiatry (Edgmont (Pa. : Township)) vol. 3,10 : 36-9.
  9. LABEL: NALTREXONE implant.” Dailymed.

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