No single naltrexone injection vs oral option fits every person. Your daily life and health history play a big role. We cover these two forms for alcohol use disorder here. Check our guide to medications for alcohol use disorder for other choices.
Our editorial team studies public health sources. We are not a treatment provider. Do not start or stop medication based on this guide. Ask a doctor about side effects and what fits you.
Naltrexone for Alcohol Use Disorder: Shot or Pill
Both naltrexone injection vs oral forms contain the same medicine. But they get into your body differently. One is a shot from a healthcare provider once a month. The other is a pill you take at home each day.[1]
Naltrexone works by blocking opioid receptors in the brain. This can lower the 'high' from drinking. That helps some people stop or drink less. It is part of a bigger plan. That plan often includes support groups and counseling.
This guide is only about alcohol use disorder. It does not use data from opioid use disorder studies to say one form is better for alcohol. Read our guide on how naltrexone works for more on how naltrexone works.
Oral Naltrexone vs Injection: Key Distinctions
Picking a daily pill or a monthly shot comes down to your lifestyle. Both aim to lower alcohol cravings. The biggest shift is in the daily routine.
Once daily
oral naltrexone is taken by mouth as prescribed[2]
Every 4 weeks
extended-release injectable naltrexone is given by a healthcare professional[3]
Naltrexone Pill vs Shot Comparison
The table highlights the practical points of each form. It does not call one superior. Convenience changes for every person. Your habits, schedule, and care access matter.
| Feature | Oral Naltrexone | Extended-Release Injectable Naltrexone |
|---|---|---|
| Route & Routine | Taken by mouth once daily as prescribed[2] | Administered by a healthcare professional once every four weeks[3] |
| Practical Advantages | No clinic visits needed; can be taken at home[2] | Removes the need for daily reminders; ensures consistent delivery[3] |
| Ask Your Clinician | "How can I build a habit to remember my daily dose?" | "Do I need to travel far for my injection appointments?" |
Consider what blocks you from following a plan. A monthly rhythm may help if you forget pills. The pill may work better if you dislike needles or clinics. Share these points with your doctor. They can help you find the best match.
Prior to starting naltrexone, your clinician checks for recent or current opioid use. They decide how long you must stay opioid-free. Ask your clinician how this safety check fits your case.
Understanding the Monthly Injection Schedule
Each dose of the monthly naltrexone injection needs a provider visit.[3] You must have steady access to a clinic that offers this. The injection handles delivering the medicine. It does not replace ongoing care. You will still go to follow-up visits to talk about progress.
Start
Discuss options with your clinician and choose a formulation that fits your lifestyle.
Routine
Follow the prescribed plan, whether that is taking a pill daily or attending an injection visit every four weeks.[2][3]
Follow-up
Return for regular check-ins to review how you are doing and adjust support if needed.
This timeline outlines the usual pattern of care. It is not a dosing instruction or treatment protocol. Your specific schedule depends on your doctor's advice and your needs.
Does the Monthly Naltrexone Injection Beat the Pill?
People with alcohol use disorder can get help from both naltrexone forms. Researchers tested each one against a placebo. There is also direct evidence comparing the two. The XON trial is a head-to-head study of the monthly naltrexone injection and the daily pill. Current direct evidence does not show one formulation is superior to the other.
An AHRQ evidence review checked the daily pill. It showed that oral naltrexone cuts the risk of going back to heavy drinking when compared with placebo.[4] So using this drug can help limit heavy drinking days more than a sugar pill does.
A separate 24-week randomized trial used extended-release injectable naltrexone. Patients who had abstained from drinking in the week before starting saw fewer heavy-drinking days than placebo.[5] These studies measure different outcomes, so they do not show which form works better.
The American Psychiatric Association notes limited evidence on long-acting injectable naltrexone versus oral formulations.[6] They suggest it may benefit adherence.[6] The injection lasts a month, so you skip remembering a daily dose. That can help if consistency is hard for you. Talk with your doctor about which option fits your life and goals.
Opioid Risks and Alcohol Withdrawal Care
Your healthcare provider needs to know if you use opioids now or recently. This covers prescription pain medicines, too. Tell them before you begin naltrexone.
Naltrexone blocks opioid effects, which can interfere with opioid-containing pain medicines and pain management.[7] If you have surgery or need pain care, your clinician must know you take naltrexone. They can adjust your pain plan to keep you safe.
You must be opioid-free before taking naltrexone. Your clinician sets the waiting time. Do not guess if you are ready. A clinician must say it is safe to start treatment.[7]
Acute alcohol withdrawal is not treated by naltrexone. Do not stop drinking at home if you drink heavily. Talk to a doctor or a treatment program for safe medical help.
As naltrexone’s opioid blockade wanes or after treatment ends, reduced opioid tolerance can increase overdose risk if a person returns to opioid use.[8] This is a serious safety issue for your care team to address. Our guide on naltrexone and opioid safety has more details.
If you suspect an overdose, call 911 or go to the nearest emergency room immediately.
Side Effects: What to Watch For and Who to Call
Side effects can happen with both forms of naltrexone.[8][7] The pill and the shot may bring different issues.[8][7] Knowing what is common helps you know when to call your doctor.
For the daily pill, commonly reported side effects include nausea, headache, dizziness, and tiredness.[8] Nausea and injection-site reactions have been reported with the monthly injection.[7] Severe injection-site reactions have also been reported and may need medical care or even surgery.[7]
Reach out to your prescriber if you feel unwell or notice anything unusual. Talk with them before changing any medications.
Get medical help right away if you see signs or symptoms of acute hepatitis.
Tracking these changes can be hard. You do not have to handle it alone. Our guide on managing medication side effects offers tips for tracking symptoms. It also helps you get ready for talks with your care team. Stay in touch with your prescriber. They can help decide if your plan needs changes.
Deciding on Care and Checking Your Insurance
You decide if a daily pill or a monthly shot is right for you. Your daily life, health history, and insurance all play a part. Use the tools below to get ready to talk with your prescriber.
Is Naltrexone Like Ozempic? Do Doctors Avoid It?
Ozempic and naltrexone are not the same. Naltrexone works as an opioid antagonist.[8] Ozempic holds semaglutide, which is a different kind of drug. They act in different ways. You cannot swap one for the other.
Some people fear that doctors do not like naltrexone. This belief is incorrect. Major guidelines list naltrexone as a standard option for alcohol use disorder.[6] It is meant for patients who are a good fit.[6] A doctor’s advice depends on your specific health needs.
What Should You Discuss With a Clinician?
This self-check is for information only and isn't a diagnosis. It helps you prepare questions for your care team.
Questions to Take to a Clinician and Insurer
Your ticks are saved on this device only.
Talk to your plan about your exact benefits. Our guide on naltrexone insurance coverage explains how plans handle these medications.
Frequently Asked Questions
What is the most effective way to take naltrexone for alcohol use disorder?
No single form is best for everyone. Evidence is limited when comparing the shot to the pill. The shot may help people stick to their plan better.[6] Talk to a clinician about your routine and health.
How long does a naltrexone injection last?
A healthcare professional gives the shot once every four weeks.[3] You do not take a pill every day. Ask your prescriber how this schedule fits your life.
Does the injection work better than the pill for alcohol use disorder?
We do not know if the shot works better than the pill. Evidence is limited for alcohol use disorder.[6] Do not mix up results from other conditions.
Why might I feel unusual or unwell while taking naltrexone?
Common side effects of the pill include nausea, headache, dizziness, and tiredness.[8] The shot can cause nausea and soreness at the injection site.[7] For non-emergency side effects, contact your prescriber. For signs of an overdose, seizures, severe confusion, hallucinations, a high fever or racing heart during withdrawal, call 911 or go to the nearest emergency room now. For thoughts of suicide or self-harm, call 911 or go to the nearest emergency room now; you can also call or text 988.
Is naltrexone like Ozempic?
No, they are different medicines. Naltrexone is an opioid antagonist.[8] Do not use Ozempic info to answer questions about naltrexone.
Why don’t doctors like naltrexone?
Doctors do not dislike naltrexone. It is a standard option for alcohol use disorder.[6] Your clinician picks the best fit for your health history.
Can oral naltrexone be started while someone is still drinking?
The APA guidance cited here does not state that someone must stop drinking before starting oral naltrexone. For people with alcohol use disorder and co-occurring opioid use disorder, it includes those who want to abstain from opioids and either abstain from or reduce alcohol use, provided they can abstain from opioids for an appropriate time before starting naltrexone.[6] In a 24-week injection trial, a subset who abstained from drinking during the week before their first dose had reduced heavy-drinking days compared with placebo; this finding does not establish an abstinence requirement for starting the injection or the pill.[5] Ask your clinician whether and when to start based on your situation.
