Naltrexone and Alcohol: Can You Drink While Taking It?

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What you will learn

• Naltrexone is an opioid antagonist, which means it blocks opioid receptors.
• Naltrexone is approved for treating alcohol use disorder and opioid use disorder.
• For alcohol use disorder, naltrexone may decrease cravings for alcohol and decrease the reward associated with consuming alcohol.
• Unlike disulfiram, also known as Antabuse, naltrexone does not cause an intentionally unpleasant reaction when alcohol is consumed.
• Even though naltrexone may allow individuals to consume alcohol without experiencing violent sickness caused by disulfiram, it does not necessarily make drinking "safe" for individuals with heavy drinking patterns, liver disease, multiple medications, or withdrawal symptoms.
• Naltrexone is not a medication for alcohol detoxification. Individuals who exhibit symptoms of withdrawal should seek immediate medical attention.

Understanding the risks of taking naltrexone and alcohol can feel confusing because naltrexone is one of the medications used to treat alcohol use disorder.

Naltrexone can be beneficial in helping individuals achieve sobriety as part of their overall treatment program for alcohol dependency; however, it should always be used under the direction of a medical professional.

It is essential to understand that naltrexone is neither a cure nor a detoxification medication for alcohol use disorder, nor is it a safe method to continue consuming large quantities of alcohol without suffering from negative consequences.

The most effective treatment plan depends on alcohol use, liver health, opioid use, withdrawal risk, mental health, and recovery goals.

What Is Naltrexone?

Naltrexone is a prescription medication approved for treating both alcohol use disorder and opioid use disorder. Naltrexone comes in two forms: oral naltrexone and Vivitrol (extended-release injectable).

Oral naltrexone exists as pills. Vivitrol is administered via a long-acting injection.

As previously mentioned, naltrexone acts as an opioid antagonist. It binds to opioid receptors and blocks opioids from activating them. In contrast to agonists (opioid substances), which stimulate these receptor sites, causing euphoria or analgesia, antagonists block these receptor sites, thereby preventing euphoric responses or pain relief.

Because it is an antagonist, naltrexone cannot produce euphoria. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that naltrexone is not addictive and does not produce withdrawal symptoms when discontinued. [1]

In treating opioid addiction, naltrexone prevents the effects of opioids (such as heroin, morphine, and fentanyl) by binding to opioid receptors. For alcohol use disorder, naltrexone works differently, affecting reward pathways involved in drinking.

Why Is Naltrexone Used for Alcoholism?

In treating alcoholism, naltrexone works differently. By blocking endogenous opioids’ effects, naltrexone influences reward pathways responsible for the pleasurable aspects of drinking.

Endogenous opioids are naturally occurring chemicals produced by the body. These endogenous opioids interact with opioid receptors in the brain to produce feelings of well-being and relaxation. When we drink alcohol, our brains respond by releasing endogenous opioids (endorphins) into the system. Endorphins can activate opioid receptors involved in pleasure and reward.

Naltrexone can potentially disrupt this process. By binding to opioid receptors and blocking their action by endogenous opioids, naltrexone can theoretically limit the ability of endogenous opioids to influence the brain regions involved in responding to the pleasurable aspects of drinking.

However, this does not mean that the desire to drink goes away completely. Some individuals note decreased cravings, and some find that drinking is less enjoyable or that it is easier to stop after fewer drinks. Regardless of how much the urge to drink diminishes, counseling, support groups, and education about recovery support remain necessary.

According to SAMHSA, naltrexone reduces cravings for alcohol by blocking alcohol-induced activation of endorphins in the brain and reducing the subjective feeling of “reward” associated with drinking. [2]

Can You Drink on Naltrexone?

Some people drink while taking naltrexone, but that does not mean drinking is safe for everyone.

Naltrexone does not cause the same kind of reaction as disulfiram (also known as Antabuse) when alcohol is consumed. Disulfiram creates an undesirable response when someone consumes alcohol.

Despite this difference in reactions to alcohol consumption, the risks associated with excessive alcohol consumption remain present. Excessive alcohol consumption can lead to intoxication, poor decision-making due to altered judgment, injury from accidents, liver damage due to excessive ethanol metabolism, and exacerbation of mental health conditions.

If an individual wants to abstain from drinking, then consuming alcohol while taking naltrexone could hinder that goal. Conversely, if a prescriber intends for a patient to use naltrexone as part of a reduction or harm-reduction strategy for managing drinking behaviors, they would need to communicate those expectations clearly to the patient.

Do not use naltrexone as a reason to drink more frequently or heavily than you did prior to taking the medication. You can still experience intoxication and engage in impulsive behavior while on naltrexone. You can also suffer from alcohol poisoning or various complications related to chronic alcohol misuse.

Can I Take Naltrexone After Drinking?

Do not ingest naltrexone while actively intoxicated or while exhibiting symptoms of withdrawal unless instructed otherwise by your healthcare provider. Generally speaking, most clinicians recommend using naltrexone after detoxification and once acute withdrawal symptoms have resolved.

SAMHSA further indicates that before beginning naltrexone for alcohol use disorder, individuals must not be physiologically dependent on alcohol or other substances. Practitioners generally delay initiation until after successful completion of a detoxification protocol, where withdrawal symptoms have diminished significantly, so as to minimize adverse reactions such as nausea and vomiting. [3]

This consideration is especially critical for those whose daily intake exceeds moderate drinking limits, those who require alcoholic beverages daily for normal functioning (tolerance), and those who exhibit significant physical withdrawal symptoms (tremors, sweating, anxiety, nausea, insomnia, fast heart rate, high blood pressure, hallucinations, confusion, seizure) upon cessation of drinking. These symptoms may point to alcohol withdrawal, which may need medical detox before naltrexone is started.

How Soon After Drinking Can I Take Naltrexone?

There is no standardized time frame that applies universally. It will depend on factors including:

• Whether you are currently intoxicated
• Your degree of withdrawal symptoms
• Your liver condition
• Your current dosage
• Your physician’s treatment plan

If you are currently prescribed naltrexone and recently drank alcohol, do not increase your dosage or alter your dosing schedule without consulting your physician first. Additionally, if you have never initiated naltrexone before and you wish to begin now, do not self-initiate treatment; instead, consult with a licensed healthcare professional regarding when to start treatment.

Naltrexone also has an important opioid safety issue. Naltrexone blocks opioid receptors. This can be dangerous if someone needs opioid pain medicine or tries to override the blockade by taking large amounts of opioids. After naltrexone wears off or is stopped, opioid tolerance may be lower, which increases overdose risk if a person returns to opioid use. This is why a healthcare provider needs to evaluate each patient’s past opioid use, current prescriptions for opioids, and any recent illicit drug use before authorizing naltrexone.

Does Naltrexone Make You Not Want to Drink?

Naltrexone may reduce your desire to drink and lessen your enjoyment from drinking, but it does not eliminate your desire entirely. Some people report having significantly less craving initially in treatment. Others report that drinking becomes less pleasurable or that they can stop earlier than they had in previous attempts. No matter how much cravings decrease, additional steps including counseling and recovery support are needed.

Naltrexone works best when incorporated into an integrated treatment plan. Potential components of this comprehensive treatment plan may include:

• Counseling
• Residential rehabilitation
• Intensive outpatient rehabilitation
• Support groups
• Alcoholics Anonymous or other peer support
• Medication management
• Mental health treatment
• Relapse prevention planning
• Family support

Additionally, recovery usually involves acquiring new ways of handling stressful situations.

What Are Common Naltrexone Side Effects?

Side effects from naltrexone can vary depending on the formulation (oral vs. injectable) and individual variability. Side effects noted for both oral formulations and Vivitrol (the extended-release injectable) share similarities, but Vivitrol can additionally generate localized irritation at the site of administration.

Common side effects reported with oral formulations and/or Vivitrol may include:

• Fatigue
• Dizziness
• Headaches
• Sleep disturbances
• Decreased appetite
• Muscle pain
• Depressed mood in some people
• Gastrointestinal symptoms including vomiting, diarrhea, nausea

Naltrexone’s United States Food and Drug Administration (FDA)-approved labeling identifies commonly reported adverse events associated with alcohol dependence trials, including nausea, vomiting, injection site reactions, muscle cramps, dizziness or fainting, drowsiness or sedation, decreased appetite, and appetite disorders. [4]

Call a healthcare provider if side effects are severe, do not improve, or include major mood changes, worsening depression, yellowing skin, dark urine, severe abdominal pain, or other signs of liver problems.

Naltrexone, Liver Disease, and Alcohol Use

Because alcohol impairs liver functioning and naltrexone is metabolized via the liver, those with liver disease, excessive drinking history, hepatitis, or a history of increased liver enzyme values should exercise caution.

A healthcare professional will assess your medical background and possible liver damage prior to prescribing naltrexone. A medical professional will likely recommend a variety of treatment options based upon individual factors such as their potential for abuse, a history of excessive drinking, previous treatments for addiction, and the presence of liver damage.

You needn’t be dishonest about past and current alcohol consumption patterns or histories of substance abuse with your physician. Honesty allows your doctor to create an appropriate regimen for you.

Naltrexone and Opioids

Naltrexone blocks opioid receptors. This can be dangerous if someone needs opioid pain medicine or tries to override the blockade by taking large amounts of opioids. After naltrexone wears off or is stopped, opioid tolerance may be lower, which increases overdose risk if a person returns to opioid use.

Patients who are actively using opioids and those with physical dependence on opioids should not receive naltrexone. Additionally, naltrexone should not be prescribed to individuals who are taking opioid medications (e.g., methadone, fentanyl) unless a qualified medical professional has first evaluated and approved this course of treatment. Similarly, patients taking buprenorphine (Suboxone) should not receive naltrexone.

Naltrexone Compared With Acamprosate and Disulfiram

Naltrexone is one among many prescription drugs utilized to treat alcohol use disorder. It can help individuals struggling with alcohol addiction by reducing cravings and diminishing the positive reinforcement associated with consuming alcohol.

Acamprosate supports maintaining sobriety in someone recovering from alcohol use disorder by stabilizing neurotransmitters disrupted during chronic alcohol use.

Disulfiram produces a negative reaction when an individual consumes alcohol. This aversive response serves as an effective deterrent to continued alcohol use.

The choice of medication depends on the specific treatment objectives of the individual, liver status, kidney status, type of drinking behavior (e.g., binge drinking), opioid use history, and whether the person can adhere to a consistent schedule for taking the medication.

When Detox May Be Needed Before Naltrexone

Naltrexone is not used to treat alcohol withdrawal syndrome. Detoxification may be a better initial option when an individual exhibits symptoms of alcohol withdrawal syndrome. Symptoms of acute alcohol withdrawal syndrome may include:

• Tremors
• Sweating
• Nausea
• Anxiety
• Insomnia
• Increased pulse rate
• Hypertension
• Hallucinations
• Confusion
• Seizure

Withdrawal can potentially lead to serious consequences, including death. Immediately seek emergency medical assistance if the above symptoms occur severely, if there is a history of having experienced either seizures or delirium tremens, or if alcohol is being combined with benzodiazepines, opioids, or other substances.

At Ascendant New York, we offer alcohol detox and rehabilitation services in New York City. Treatment begins with an assessment of the individual’s overall treatment needs to determine the appropriate level of care.

If you’re experiencing difficulty managing alcohol use, withdrawal symptoms, or have questions regarding naltrexone, contact us for further support.