In the brain, naltrexone blocks opioid receptors. This can make alcohol feel less rewarding. It may help you drink less or handle cravings. It is not a cure. It does not ensure you will stop drinking. Nor does it treat alcohol withdrawal.
If you have severe withdrawal symptoms, call 911 or go to the nearest emergency room now.
This guide explains how naltrexone affects cravings. It also lists safety questions for your prescriber. We run a U.S. treatment directory as an editorial team. We are not a treatment provider. See our guide on medications for alcohol use disorder for other options.
How Naltrexone for Alcohol Use Disorder Works
By blocking opioid receptors in the brain, naltrexone affects the reward system. This action may help cut down on the urge to drink and lower cravings.[1]
Keep your expectations realistic. This medicine does not erase cravings. It aims to make urges feel less strong. That can help you follow your plan.
Group averages provide the data on naltrexone for alcohol use disorder. This is not a forecast for you alone. Doctors check the number needed to treat (NNT). This tells how many people must take the drug to stop one bad outcome in a group.
12
people treated to prevent one return to heavy drinking[2]
20
people treated to prevent one return to any drinking[2]
Studies comparing naltrexone to a control group create these estimates. They are not guarantees or personal odds. Your results may vary based on your health history.
Treatment goals are unique to you. Stopping alcohol completely is a valid goal. Cutting down heavy drinking is also a valid goal. Talk with your clinician about what fits your life. They can help you pick the right path.
How Treatment Works and the Sinclair Method
There are two main forms of naltrexone. You can take a pill every day. Or you can get a monthly shot known as Vivitrol.[3] This shot treats alcohol dependence.[3] Our guide to naltrexone injection vs oral compares the side effects and safety profiles of both delivery methods.
How well naltrexone works can differ for each person. It does not promise you will quit drinking. The American Psychiatric Association calls it a good choice for many. This holds true for moderate to severe alcohol use disorder. You should want to cut back or stop. Also, you must have no medical reason to skip it.[2] If you are weighing choices, check our guide on naltrexone vs acamprosate. For a closer look at that alternative, our guide to acamprosate for alcohol use disorder explains how it works and its side effects.
| Format | What it is | Talk to your prescriber about |
|---|---|---|
| Oral naltrexone | A daily pill taken by mouth | How it fits your daily routine and other meds |
| Extended-release injectable (Vivitrol) | A monthly shot from a provider | Whether and how long you need to be opioid-free before the shot |
| The Sinclair Method | A way to use naltrexone while drinking | If this approach matches your treatment goals |
A Look at the Sinclair Method
The Sinclair Method uses naltrexone in a specific way. It combines the medication with alcohol use. The aim is to lower drinking over time. It is not a distinct drug.
If you are thinking about this approach, talk with a qualified prescriber. They can tell you if it fits your treatment goals.
Web guides may seem like steps to follow. Yet they are not medical advice. Do not start, stop, or shift your dose using the internet. Speak with a qualified prescriber first. They can say if this path fits you. Our guide on asking your doctor about medication offers tips for that talk.
Drinking While on Naltrexone: What to Expect
Taking naltrexone and drinking alcohol does not lead to a disulfiram-like reaction or an aversive physical response.[4][5] Yet, it does not stop alcohol’s effects or make drinking safe. If you are comparing medication options, our guide to disulfiram for alcohol use disorder explains how that treatment works.
Naltrexone is often used to help cut back on drinking or support abstinence. Talk to your prescriber about your goals and any times you drank. They can help decide if the medication still fits your treatment plan.
Do not take extra medication if you already drank. Do not stop your treatment on your own. Talk to your prescriber for advice that fits your needs. You can also read our guide on relapse on alcohol medication for more help.
Naltrexone Side Effects and Why It May Not Fit
Naltrexone works well for most people. However, certain side effects happen often. Knowing what to expect helps you talk with your prescriber.
| Area | What may occur | What to discuss with a prescriber | When to seek medical advice |
|---|---|---|---|
| Common oral effects | Nausea, headache, dizziness, or fatigue[6][4] | How to manage symptoms or if a dose change is okay | If symptoms are bad or do not go away |
| Liver health | Liver injury or hepatitis has been reported with naltrexone[7] | Your liver history and any new symptoms like dark urine or yellow skin | If you notice signs of liver trouble, call your care team soon |
| Opioid use | Naltrexone can block opioid pain medicines[8] and may trigger withdrawal in people dependent on opioids[9] | All current opioid medicines, including pain relief, cough, or cold products | If you take opioids, tell your prescriber before starting naltrexone |
| Injection site (Vivitrol) | Pain, tenderness, swelling, redness, bruising, or itching at the injection site[10] | Any changes at the injection site, especially if they worsen | If you see signs of serious infection or tissue damage, contact your care team promptly |
If you take opioids for pain, naltrexone may not be the right choice now. It can stop opioid-based meds for pain, cough, or colds from working. Tell your clinician about this before getting pain care.[8] Also, people dependent on opioids may go into withdrawal with naltrexone.[9] Learn more in our guide on naltrexone and opioid use.
Important Safety Warning: Opioid Overdose Risk
Naltrexone stops opioids from having an effect. This creates a safety risk: if you skip a dose or stop, your body’s tolerance to opioids may drop. If you then use opioids, even at a dose you previously tolerated, you are at risk for a serious or fatal overdose. Do not take extra opioids to beat the blockade. Always speak with your prescriber before using any opioid while on naltrexone or soon after quitting it. If you or someone else shows signs of an opioid overdose, such as unresponsiveness, slow or stopped breathing, or blue-tinged lips, call 911 immediately. If you have naloxone, use it while you wait for emergency help.
Liver health is another point to bring up. Naltrexone has been linked to liver injury and hepatitis. Do not make a diagnosis yourself. Share your full history so your team can keep you safe.
Oral naltrexone can cause nausea as a side effect. This made some patients quit the medication.[6] People also report headaches, dizziness, and tiredness.[4] Tell your prescriber if these issues bother you. Check alcohol medication side effects to learn about other medications.
Naltrexone Is Not for Alcohol Withdrawal
Naltrexone is for alcohol use disorder, not for acute alcohol withdrawal. It does not treat withdrawal symptoms.[11] If you are worried about withdrawal, get a medical check.
This check helps you find your safest next step.
What Kind of Help Is Safest Now?
This self-check is for information only and isn't a diagnosis. It cannot tell if it is safe to withdraw without medical care.
Nutrition and Supplements: Key Facts
We need more rigorous studies with enough power to settle most complementary approaches for substance use disorders.[12]
People often want to know which supplements lower alcohol cravings. No clear answer exists yet. Check with a clinician or pharmacist before starting any new product. Some dietary supplements can mix with prescription medicines. This can hurt safety or change how your medication works.[13]
You may also ask about vitamin gaps in alcohol use disorder. Heavy drinking can stop your body from using thiamine (vitamin B1) well.[14] Alcohol-related nutrition problems often hit many nutrients at once. Low levels of folate and vitamins A, D, and E are common.[15]
Do not guess which nutrient you lack. Talk to a clinician about your nutrition and any supplements you plan to take.
Naltrexone for Alcohol Use Disorder: Timing and Review
Naltrexone for alcohol use disorder has no set day when cravings fully drop. Blood drug levels and how you feel are not the same thing. Oral naltrexone hits peak blood levels in about an hour, but this timing does not say when you will notice less craving.[16] Your prescriber will not give a specific date for change. Instead, treatment is an ongoing talk about your goals, drinking, and how the drug fits your life.
Before starting
You and your prescriber discuss your health history, current medications, and personal goals for drinking.
Early follow-up
You track cravings, drinking patterns, and any side effects. This helps you and your care team see if the plan is working for you.
Ongoing reviews
You meet regularly to check if benefits and treatment goals remain aligned. You can adjust the plan if it no longer fits.
Some studies use fixed times to track results. The COMBINE trial looked at oral naltrexone over 16 weeks.[17] Another trial of the extended-release injectable form watched patients for 24 weeks.[10] These lengths are research plans, not orders for how long you should take the drug.
VA/DoD guidance advises checking how well treatment works and how you tolerate it at follow-ups. It does not treat one study's time frame as a standard course for everyone. They suggest regular checks using valid, standard tools to track your response.[18] This keeps the plan a good fit for you. Do not start, stop, or shift your dose alone. Tell your prescriber about any worries or changes in how you feel. Our guide to monitoring alcohol medication progress helps you track your response and prepare questions for your next follow-up.
Talking to Your Doctor and Locating Naltrexone for Alcohol Use Disorder
The best way to know if naltrexone fits you is to talk with your prescriber. Have a list of questions ready. This helps you discuss your health history and goals.
Questions to Take to a Prescriber
Your ticks are saved on this device only.
You can also read our guide on asking your doctor about medication for more details. Behavioral treatments can be used alongside medication to support your goals as part of care for alcohol use disorder.[19] For a closer look at the behavioral side, our guide to CBT for alcohol use disorder explains the techniques and session flow.
Look for local care using the free SAMHSA National Helpline. It offers confidential treatment referrals any time.[20] You can also search for substance use treatment services in the U.S. via SAMHSA’s FindTreatment.gov.[21]
Frequently Asked Questions
How long does naltrexone take to work for alcoholism?
There is no single day when everyone feels a change. After taking the pill, peak blood levels hit within about one hour.[16] This timing does not tell you when you will feel fewer cravings. Track your urges and drinking over the next few weeks. Check in with your prescriber to review your progress. Do not stop or change your treatment just because you do not feel a quick difference.
What happens if you drink alcohol on naltrexone—does it cause a disulfiram-like reaction?
Naltrexone does not cause the severe reaction seen with disulfiram. But drinking while on this medicine is not safe. It can hurt your treatment goals. If you have already drunk, do not take extra medicine or stop without advice. Call 911 or go to the ER now if someone cannot wake up, has trouble breathing, or has a seizure.[22]
What is the downside of taking naltrexone?
Side effects and health issues decide if this medicine fits you. Look at the side-effect list from your provider. Talk to your prescriber about any worries. If you use the shot, ask about site reactions like tenderness or swelling.[10] Your doctor can help weigh the risks and benefits for you.
Why don't doctors like naltrexone?
Doctors do not generally dislike naltrexone. They may pick other options based on your health history. Other medicines, personal choices, or goals can shape this choice.[2] Naltrexone is an option for some patients, not all.[2] Ask your prescriber why they chose this path and what else is available.
What supplements can help reduce alcohol cravings?
No supplement replaces professional treatment for alcohol use disorder. Some products claim to cut cravings, but proof varies. Ask a clinician or pharmacist before using any product. This is key if you take naltrexone to avoid bad interactions.
What vitamin deficiency do people with alcohol use disorder get?
Alcohol use can lead to many nutritional gaps, not just one vitamin shortage. Every body reacts differently, so no single gap fits everyone. A medical check-up is the best way to find any missing nutrients. Do not guess or start supplements without talking to your care team first.
What is the Sinclair Method?
The Sinclair Method pairs medicine with specific drinking patterns. Research exists on this method, but it is not a safe self-directed plan for everyone. Read the earlier section in this guide for a basic overview of how it works. Always work with a licensed pro to build a safe plan for you.
Is naltrexone a treatment for alcohol withdrawal?
No, naltrexone does not treat alcohol withdrawal on its own. Withdrawal signs can start 6 to 24 hours after you cut back or stop drinking.[23] Alcohol withdrawal can be life-threatening.[24] Call 911 or go to the ER now for seizures, severe confusion, hallucinations, a high fever, or a racing heart during withdrawal. For withdrawal symptoms that are not emergency danger signs, seek timely medical care.
