Naltrexone Interactions: What You Need to Know

Naltrexone is one of the most commonly used medications for treating opioid (also called narcotics) and alcohol use disorders. It’s a controlled substance, which means it’s important to know what to avoid when taking naltrexone.

According to estimates, over 6.1 million people in the US have an opioid use disorder (OUD). Likewise, the 2023 National Survey on Drug Use and Health (NSDUH) reports that 224.3 million people ages 12 and older said they had consumed alcohol at some point in their lifetime. Both opioids and alcohol should not be taken alongside naltrexone. In this article, we will talk about other similar interactions with common medications.

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What Is Naltrexone?

Naltrexone is an FDA-approved medication used to treat both opioid use disorder (OUD) and alcohol use disorder (AUD). This drug is often used during medication-assisted treatment. Depade, ReVia, and Vivitrol are the different brand names of naltrexone. It is available as an oral tablet or an intramuscular (IM) injection. 

Wondering where to get a naltrexone injection from? Call 844.445.2565 or fill out this form to get in touch with our DEA-certified healthcare providers. 

How Does Naltrexone Work?

Naltrexone is used after opioids or alcohol have been cleared from the body through medical detox. It works by blocking parts of the brain that produce feelings of being “high” or intoxicated from substances like heroin, morphine, or alcohol, as it is an opioid antagonist. By doing so, naltrexone performs two main functions:

• Reduce cravings and the desire to use opioids or alcohol 
• Minimize the risks of relapse

Naltrexone binds to opioid receptors without activating them, effectively blocking the effects of opioids. This action helps reduce cravings and the urge to use opioids again.

Top 4 Naltrexone Interactions to Watch Out For

Naltrexone can interact with alcohol, herbal supplements, and even over-the-counter (OTC) medicines. That’s why using it with certain other medications or substances can cause adverse effects that may be very risky for your body. Naltrexone’s interaction with some drugs may increase liver problems and interfere with the body’s natural handling of stress, pain, and cravings. That’s why understanding such interactions is essential for staying safe. 

1. Opioid Medications

According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 125 million opioid prescriptions were given to American patients in 2023. Naltrexone blocks the pain and pleasure receptors, preventing the euphoric and rewarding effects of opioids. 

When someone dependent on opioids takes naltrexone, it can trigger sudden and severe withdrawal symptoms. These may include:

• Nausea
• Vomiting
• Headache
• Irritability
• Heavy sweating

Taking naltrexone while opioids are still in the system can lead to potentially dangerous consequences. That is why a medical detox beforehand is necessary.
Some of the common opioid medications include:

• Morphine
• Codeine
• Opium
• Heroin
• Pain Relievers

Medicines that are used to provide relief from pain work by activating opioid receptors and trigger endorphins, which are chemicals in the brain and nervous system. These chemicals help create feelings of pleasure and comfort. As naltrexone blocks the functionality of these receptors, some of these pain-relieving medications don’t work properly. It’s recommended that, before using naltrexone, you should inform your doctor about what pain relievers you are using.

2. Antidepressants and Antipsychotics

Antidepressants are used to treat depression and related issues, while antipsychotics are used for the treatment of psychosis, such as schizophrenia. For example, Thioridazine is used to treat schizophrenia and, if used with naltrexone, can increase sleepiness. As a general rule, while taking naltrexone, the antidepressants and antipsychotics should be used after consulting with the doctor.

3. Medications for Anxiety or Sleep

Some medications used to treat anxiety or sleep disorders may interact with naltrexone and increase the risk of side effects, such as excessive drowsiness. For example, combining naltrexone with sedatives or sleep aids (like benzodiazepines) can increase the risk of sedation and breathing problems. 

While naltrexone is sometimes prescribed alongside Disulfiram for alcohol use disorder, this combination can increase the risk of liver damage. That’s why these medicines must be used under the supervision of a qualified doctor, and the patient should be regularly monitored.

4. Other Substance Use Disorder Medications

Some medicines, such as Methadone and Buprenorphine, are also used for the treatment of opioid use disorder. These medicines shouldn’t be used with naltrexone because it blocks how these medications work in the body. For example, methadone use with naltrexone can result in sudden and intense withdrawal symptoms.

Naltrexone Side Effects

Can You Drink Alcohol on Naltrexone?

Drinking on naltrexone is not recommended. While there isn’t a direct interaction, naltrexone can lessen the feeling of alcohol intoxication, which can make a person drink more than intended. This may lead to alcohol poisoning. More reasons are written below:

• Abstain from alcohol before using naltrexone to speed up recovery. During treatment, naltrexone decreases the euphoric effects of alcohol, which helps treat alcohol dependency. 
• Naltrexone will not prevent other side effects of alcohol, such as impaired coordination, judgment, reaction time, speech, and the emotional or behavioral triggers. That’s why naltrexone is part of a treatment plan where support groups and behavioral therapies are used.

Vitamins, Herbs, and Food Interactions

There are no reported interactions of naltrexone with vitamins, herbs, or food supplements. However, these interactions may become obvious after further research. That’s why you should consult your doctor at every step of your treatment process using naltrexone.

Health Conditions That May Affect Naltrexone Prescription

1. Liver Disease

Using heavy doses of naltrexone can damage your liver. If you already have liver disease, inform your doctor about it. You should also ask your doctor for periodic liver monitoring during the treatment process.

2. Kidney Function

Naltrexone is primarily processed by the liver, but a portion of it goes through the kidneys. A healthy kidney will eliminate these parts of the medicine, but, in case of kidney problems, they may build up in the body.

3. Pregnancy and Breastfeeding

Pregnant women are not recommended to take naltrexone because major medical organizations say there is not enough data to fully understand how this medication might affect the baby during pregnancy. Research so far has not shown harmful effects on breastfeeding while using naltrexone, but studies are limited. If you’re breastfeeding, it’s important to consult your doctor to weigh the benefits and risks for both you and your baby.

4. Psychiatric Conditions

Different studies have found, though not exclusively, that some people with co-occurring addiction and depression felt better after their substance use decreased. However, in people with existing depression or bipolar disorder, the mood may worsen after using naltrexone. That’s why people with mood disorders should inform their doctor before starting naltrexone.

Free Addiction Assessment

Please note this assessment is an initial self-screening, and it is not meant to be a medical assessment or clinical diagnosis of addiction. For proper diagnosis and treatment, schedule an appointment with ChoicePoint.

Signs of an Interaction or Adverse Reaction

Some adverse reactions to naltrexone interaction with other substances may occur during the treatment. These signs of an interaction may include:

• Sudden withdrawal symptoms
• Liver problems (yellowing of skin/eyes, dark urine)
• Confusion, dizziness, severe drowsiness

NOTE: If you notice any of the symptoms above, seek help immediately. This could be very serious. 

Common Side Effects of Naltrexone

Common side effects of using naltrexone include:

• Nausea or vomiting
• Reduced appetite
• Joint discomfort or pain
• Muscle cramps or aches
• Headache
• Dizziness
• Drowsiness or fatigue
• Difficulty sleeping (insomnia)
• Toothache
• Cold-like symptoms (e.g., nasal congestion, sneezing, sore throat)
• Feelings of anxiety or nervousness

Naltrexone Therapy at ChoicePoint

ChoicePoint specializes in medication-assisted treatment, and naltrexone is an important part of the treatment. Whether you struggle with alcohol use disorder or opioid use disorder, naltrexone may be prescribed after a medical assessment. You may get the following levels of care (as per your treatment needs):

• Inpatient Treatment
• Outpatient Treatment
• PHP/ Partial Care
• Telehealth Treatment

Feel free to talk to our specialists by booking an appointment at 844.445.2565 or on this form. 

FAQs

How many drug interactions are there with Naltrexone?

Naltrexone is known to interact with a total of 352 medications. These interactions are classified as:

• 34 major interactions – These can be serious and potentially dangerous. Combining naltrexone with these drugs should generally be avoided unless specifically directed by a healthcare provider.
• 318 moderate interactions that require monitoring, dose adjustments, or timing considerations.

Are there any supplement interactions with Naltrexone?

In case you are using supplements and prescribed naltrexone, you should talk with your doctor. This is the best way to remain safe from any possible adverse interactions. 

Can I use over-the-counter pain relievers with Naltrexone?

Generally, non-opioid over-the-counter pain relievers, such as Tylenol or NSAIDs, are considered safe to use with naltrexone. However, providing details of all the medications you use is essential, and sometimes crucial.

What should I do if I’m prescribed a new medication while on Naltrexone?

First of all, you need to inform your doctor that you are using naltrexone. Secondly, if you feel any side effects, quickly seek medical help.

Can Naltrexone be taken with medications for chronic conditions like diabetes or high blood pressure?

Some diabetes drugs, for example, pioglitazone, can increase the risk of liver problems when used with naltrexone, which may also cause this health condition. Likewise, using naltrexone is generally considered safe, but medications like labetalol can affect liver function. That’s why you should always consult with your healthcare provider when using naltrexone with other medications.

Sources

1. Research, C. F. D. E. A. (2024, December 26). Information about Medications for Opioid Use Disorder (MOUD). U.S. Food And Drug Administration. https://www.fda.gov/drugs/information-drug-class/information-about-medications-opioid-use-disorder-moud
2. Alcohol Use Disorder (AUD) in the United States: Age groups and demographic characteristics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics
3. About prescription opioids. (2025, March 7). Overdose Prevention. https://www.cdc.gov/overdose-prevention/about/prescription-opioids.html
4. Wachman, E. M., Saia, K., Bressler, J., Werler, M., Carter, G., & Jones, H. E. (2024). Case series of individuals treated with naltrexone during pregnancy for opioid and/or alcohol use disorder. Journal of Addiction Medicine, 18(3), 288–292. https://doi.org/10.1097/adm.0000000000001293