For alcohol use disorder, naltrexone blocks opioid receptors in the brain. This can make alcohol feel less rewarding. It may help you control cravings or cut back on drinking. It is not a cure. It does not ensure you will quit drinking. It also does not treat alcohol withdrawal.
If you have severe withdrawal symptoms, call 911 or go to the nearest emergency room now.
This guide shows how naltrexone helps with cravings. It also gives safety questions for your prescriber. Our editorial team runs a U.S. treatment directory. We do not act as a treatment provider. See our guide on medications for alcohol use disorder for more options. For a broader look at medication and counseling for AUD, see our guide to mat for alcohol use disorder.
Naltrexone for Alcohol Use Disorder: Its Action
In the brain, naltrexone blocks opioid receptors. These spots are part of the reward system. This block may help lower cravings and the urge to drink.[1]
Set realistic expectations. This medicine does not erase cravings. It aims to make urges feel weaker. That can help you follow your plan.
Doctors use the number needed to treat (NNT) to show group results. This figure counts how many people take the drug to stop one bad outcome. Data on naltrexone for alcohol use disorder comes from these averages, not your personal case.
12
people treated to prevent one return to heavy drinking[2]
20
people treated to prevent one return to any drinking[2]
Estimates from studies comparing naltrexone to a control group form these numbers. They are not guarantees or your personal odds. Your health history may lead to different results.
What you aim for is up to you. You might want to cut back on heavy drinking. Or you may wish to stop alcohol altogether. Both are fair goals. Ask your clinician what fits your life best. They can guide you to the right path.
Ways to Use Naltrexone and the Sinclair Method
Naltrexone comes in two forms. One is a pill you take every day. The other is a monthly shot called Vivitrol.[3] Vivitrol is used to treat alcohol dependence.[3] Our guide to naltrexone injection vs oral breaks down the differences in dosing and how each form works. If you are comparing costs, our guide to insurance coverage for naltrexone explains how to verify your specific prescription benefits.
How well naltrexone for alcohol use disorder works depends on the person. It does not promise you will quit drinking. The American Psychiatric Association says it is a good option for many. This applies to those with moderate to severe alcohol use disorder. You should want to cut back or stop. You must also have no medical reasons to avoid it.[2] If you are looking at choices, read our guide on naltrexone vs acamprosate.
| 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 |
What the Sinclair Method Involves
Naltrexone is used in a method called The Sinclair Method. This method combines the drug with drinking alcohol. Aiming to lower drinking amounts over time is its goal. It is not a different kind of medicine.
If you are considering this approach, talk with a qualified prescriber. They can help you learn whether it fits your treatment goals.
Online guides can look like instructions. However, they do not count as medical advice. Do not alter, begin, or end your dose using online info. First, speak with a qualified prescriber. They can say if this path fits your needs. See our guide on asking your doctor about medication for tips on that chat.
Naltrexone for Alcohol Use Disorder: Drinking Effects
Drinking while on naltrexone does not trigger a disulfiram-like reaction or aversive physical response.[4][5] But it does not block alcohol’s effects or make drinking safe.
Because naltrexone is often used to help reduce drinking or support abstinence, it is important to discuss your specific goals and any instances of drinking with your prescriber. They can help determine if the medication is still the right fit for your treatment plan.
If you drank, do not add extra doses of the medication. Also, do not end your treatment on your own. Get advice from your prescriber that fits your needs. You can also read our guide on relapse on alcohol medication for more help.
Why Naltrexone May Not Work and Its Side Effects
Many people do well on naltrexone. Yet some side effects are common. Being aware of them helps you chat 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 right now. It can stop opioids used for colds, cough, or pain from working. Tell your clinician before you get pain care.[8] Naltrexone may also cause opioid withdrawal in people who rely on opioids.[9] See our guide on naltrexone and opioid use for details.
Important Safety Warning: Opioid Overdose Risk
Naltrexone stops opioids from working. There is a safety risk if you stop or miss a dose. Your body’s tolerance to opioids may go down. 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 more opioids to fight the block. Talk to your prescriber before using any opioid while on naltrexone or right after stopping 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 factor to discuss. Reports link naltrexone to liver injury and hepatitis. Please do not make your own diagnosis. Tell your team your full history to help them keep you safe.
Oral naltrexone can cause nausea as a known side effect. Some patients stopped the drug because of it.[6] Dizziness, headaches, and tiredness are also reported.[4] Tell your prescriber if these issues bother you. Check alcohol medication side effects for details on other medications.
Naltrexone Does Not Treat Alcohol Withdrawal
Naltrexone for alcohol use disorder is its main use. It is not meant for acute alcohol withdrawal or its signs.[11] A medical check is needed if you fear withdrawal.
Take this check to see what the safest next step is for you.
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.
Dietary Add-Ons and Food: Basics
We need more rigorous studies with enough power to reach clear findings on most complementary approaches for substance use disorders.[12]
Is there a supplement that cuts alcohol cravings? No one knows for sure yet. Check with a clinician or pharmacist before adding anything new. Some dietary supplements can react with prescription drugs. This reaction can lower safety or shift how your medication works.[13]
You might ask which vitamin shortages impact those with alcohol use disorder. Drinking heavily can stop your body from using thiamine (vitamin B1) well.[14] Nutrition problems tied to alcohol often hit many nutrients together. Common low levels include folate and fat-soluble vitamins A, D, and E.[15]
Do not try to guess what your body lacks. Bring up your food worries and any planned supplements with a clinician.
Naltrexone for Alcohol Use Disorder: Start Time and Care Checks
There is no set day when naltrexone for alcohol use disorder fully cuts cravings. How you feel is not the same as drug levels in your body. After taking oral naltrexone, blood levels hit a peak in about one hour. This timing does not show when you will notice less craving.[16] Your prescriber will not promise a specific date for change. Instead, care is a steady 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.
Researchers sometimes set a fixed length of time to test a drug. In the COMBINE trial, people took oral naltrexone for 16 weeks.[17] Another study tracked users of the extended-release injectable form for 24 weeks.[10] These times show how the research was built, not how long you should take the medication.
VA/DoD guidance says to check how well treatment works and how you handle it during follow-ups. It does not use one study’s time as a standard course for all. It suggests regular checks with valid, standard tools to track your response.[18] This helps keep the plan right for you. Never start, stop, or change your dose on your own. Tell your prescriber about any worries or changes in how you feel. Our guide to monitoring alcohol medication progress covers how to track your response and what to discuss at follow-ups.
What to Ask Your Prescriber About Naltrexone for Alcohol Use Disorder
Chatting with your prescriber is the top way to check if naltrexone works for you. Write down your questions. This helps you share 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. Medication and behavioral treatments can work together to help you reach your goals in alcohol use disorder care.[19] For a closer look at pairing these approaches, see our guide to medication and therapy for alcohol use disorder.
If you want to explore local options, you can use the free and confidential SAMHSA National Helpline for treatment referrals anytime.[20] You can also search for substance use treatment services in the United States through SAMHSA’s FindTreatment.gov service.[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.
