Naltrexone & Alcohol: Can I Drink While on Natrexone?

What is Naltrexone?

The opioid antagonist Naltrexone (brand names: ReVia, Vivitrol, and Depade) is a medication that is FDA-approved to treat those who suffer from alcohol use disorders and opioid use disorders.¹ The drug comes in a pill form (Depade and the more popular version ReVia) and as an extended-release injectable form (Vivitrol). Naltrexone is designed to reduce and suppress cravings for alcohol or opiate drugs. It does this by binding to the opioid receptors in the person’s brain (thereby removing any opiate drugs on these receptors) and suppressing cravings.

Naltrexone is considered to have no abuse potential and does not result in the development of physical dependence. An individual must obtain a prescription in order to legally obtain it, and the medication is typically used in situations where individuals are actively recovering from alcohol use disorders or opiate abuse.

Naltrexone does not treat withdrawal symptoms; rather, it is designed to suppress cravings for alcohol or opiate drugs. Individuals with moderate to severe alcohol use disorders who are using naltrexone may experience withdrawal symptoms if they stop drinking that can be potentially fatal due to the development of seizures. These individuals should consult with an addiction medicine physician or psychiatrist before discontinuing their use of alcohol.

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Side Effects of Naltrexone

Naltrexone is considered safe to use and associated with few side effects; however, all medications have a side effect profile. Side effects as a result of naltrexone use are reported to be relatively rare, but they do occur in some instances. Some include:²

• Nausea, stomach cramps, and diarrhea are the most common reported side effects; however, these typically resolve over time.
• Some individuals may experience muscle stiffness, cramps, and headaches.
• Sleep disruptions (including both insomnia and hypersomnia), anxiety, and dizziness have also been reported.
• Individuals should not use opiate drugs while taking naltrexone. People who use opiate drugs and take naltrexone may experience opioid withdrawal symptoms as naltrexone is an opioid antagonist. The Food and Drug Administration (FDA) recommends that individuals who use naltrexone should be abstinent from opioid drugs for a week to 10 days.^1,2 Because naltrexone is an opioid antagonist, people using it and who also use opioid medications for their psychoactive effects will not experience the typical “high” that they get from opiate drugs. This may result in individuals taking more opiate drugs than they normally would and potentially overdosing on opiates.
• Pregnant women should not use naltrexone.

Drinking Alcohol while Taking Naltrexone

There appear to be no significant dangers associated with taking naltrexone and drinking alcohol. Information provided by the FDA and by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) report that individuals who drink alcohol and use naltrexone:³

• Will still experience the functional impairments that are associated with alcohol use, such as a loss of motor coordination, decreased response time, problems with slowed rates of thinking, etc.
• May experience less of an urge to drink more alcohol.
• May reduce their alcohol intake.

Thus, research supports the notion that naltrexone is effective in reducing alcohol intake but not effective in promoting abstinence from alcohol. Individuals in these studies often continued to drink alcohol while on naltrexone, and there were no significant or dangerous effects noted. In fact, one method of treating alcohol use disorders known as the Sinclair Method suggests that individuals take naltrexone about one hour before they begin drinking alcohol.⁴ At least one research study has suggested that taking naltrexone in this manner (only taking the drug one hour before one is planning to drink alcohol) results in a significant reduction in alcohol cravings and intake compared to the suggested use of naltrexone, which is to take it in the morning and attempt to remain abstinent from alcohol. The developer of this method, Dr. Sinclair, reported that using naltrexone before drinking alcohol in this manner is significantly more effective in reducing alcohol intake than using naltrexone as an attempt to help the person become or remain abstinent from alcohol. These research reports still need further investigation and replication.

Research Findings & Effectiveness

The standard method of using naltrexone is for individuals in recovery from alcohol use disorders or opiate use disorders to take the medication in the morning while trying to remain abstinent from these drugs.

Research findings are mixed, but overall, they tend to support the notion that individuals who use naltrexone to treat alcohol abuse reduce the total amount of alcohol they consume and observe a reduction in the number of times they drink alcohol. In addition, heavy drinkers often notice significant reductions in alcohol use. However, the research does not indicate that the use of naltrexone is effective at assisting individuals in remaining totally abstinent, but it does most likely result in a significant reduction in cravings for alcohol and an overall reduction in the amount of alcohol consumed.

Research findings do not suggest that naltrexone is a cure-all for alcoholism. Rather, taking naltrexone should be accompanied by formal substance abuse treatment.

Does Insurance Cover Drug & Alcohol Addiction Treatment?

Yes, insurance typically covers alcohol and drug addiction treatment, as well as medication-assisted treatment. However, the extent of your treatment coverage depends on various factors, including your particular health insurance benefits, your provider, and more. Check your insurance coverage below.

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Conclusions

There appear to be no recorded significant dangers of drinking alcohol while taking naltrexone. There is research that suggests that the drug may be more effective in reducing alcohol intake if it is taken prior to drinking alcohol as opposed to using it and attempting to remain abstinent from alcohol. This research needs to be replicated.

Sources

1. Substance Abuse and Mental Health Services Administration. (2021). Naltrexone.
2. Food and Drug Administration. (2017). Revia.
3. National Institute on Alcohol Abuse and Alcoholism NIH Publication. (1995). Answers to Frequently Asked Medication Questions: Naltrexone,
4. Sinclair J. D. (2001). Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol and alcoholism (Oxford, Oxfordshire), 36(1), 2–10.
5. Johnson B. A. (2007). Naltrexone long-acting formulation in the treatment of alcohol dependence. Therapeutics and clinical risk management, 3(5), 741–749.