Naltrexone: Medication for Alcohol Use Disorder

Naltrexone is a safe, effective, FDA-approved medication used to treat Alcohol Use Disorder. It has been shown in numerous studies to reduce heavy drinking, frequency of drinking, cravings for alcohol and relapse to alcohol dependence. Naltrexone HCL (hydrochloride), oral naltrexone medication, comes in 50mg tablet form and is taken daily by mouth. If you’re interested in naltrexone, complete our online assessment and Oar will connect you with a licensed medical professional who can determine whether a prescription is right for you.

Alcohol Use Disorder (AUD) is a common medical condition that around 30 million Americans experience. People with AUD have trouble stopping or controlling their alcohol use despite negative consequences from drinking. Consequences may include problems with family or friends, problems at work, or negative physical and mental health impacts. To be diagnosed with AUD a person must meet certain, specific criteria. Alcohol Use Disorder is not “alcoholism.” You may have already noticed here at Oar we do not describe naltrexone as “medication for alcoholism” or use the term “alcoholism” in general. Alcoholism is not a modern diagnostic term. Whereas “alcoholism” has historically referred to the most serious cases of alcohol dependence, AUD includes multiple levels of severity (mild, moderate, and severe) that may be diagnosed based on the number of symptoms present. An AUD diagnosis acknowledges that problems with alcohol exist on a spectrum and each individual has their own unique relationship with alcohol. As serious as consequences of alcohol misuse may be or as intimidating as an AUD diagnosis may feel, treatment works. All types of Alcohol Use Disorder – mild, moderate or severe – can get better with treatment. Medication for AUD, like naltrexone, can be an effective treatment, as well as counseling, therapy, and mutual support groups. A trained, licensed medical professional can assess your alcohol use and whether prescription medication is an appropriate fit for you once you complete an online assessment. For much more in-depth information on AUD, consult our Reference Library.

Naltrexone works by disrupting the chemical feedback loop that can make it difficult for a person to stop drinking once they have already consumed a few drinks. Naltrexone is an opioid antagonist that goes to work where AUD begins — in the brain. The medication combats AUD by binding to opioid receptors in the brain, blocking the pleasure and reward typically associated with alcohol consumption. Breaking this feedback loop reduces cravings and makes controlling alcohol consumption easier. Taking naltrexone for AUD means not having to rely on willpower alone to drink less or abstain from drinking entirely.

Yes. Multiple clinical studies have found that treatment with naltrexone can lead to decreased alcohol cravings. Other benefits of naltrexone supported by research include fewer thoughts about alcohol, less interest in daily drinking, reduced appeal of alcohol, and less interest in heavy drinking. Please refer to the naltrexone section of our Reference Library to read some of the peer-reviewed clinical studies showcasing the benefits of naltrexone for treatment of alcohol problems.

Naltrexone is a safe, effective medication. Naltrexone is not an addictive substance and will not cause those who take the medication to feel intoxicated or “get high.” However, naltrexone is not appropriate for people who are currently using heroin, fentanyl or opioid-based pain medications because it can cause opioid withdrawal symptoms. (Naltrexone is FDA-approved for the treatment of opioid use disorders following opioid detoxification.) As with all medications, naltrexone does hold the risk of side effects. However, the side effects of naltrexone are rare and usually mild. Some potential side effects include dizziness and headache, but the most common is nausea or “tummy troubles.” For more info please jump to ‘What Are the Side Effects of Naltrexone?’

Half life is a measure of how long it would take half of a dose of a drug to be processed and eliminated. For naltrexone, the average elimination half-life of naltrexone is between 4 hours and 13 hours. Half-life does not indicate the time it would take an entire dose of naltrexone to leave the system and it usually takes several half-lives before a drug is fully eliminated. The amount of time naltrexone remains detectable in your system depends on the form of naltrexone taken and the testing method used to detect it. The immediate-release pill form of naltrexone (also known as naltrexone HCL) can be detected in urine for 4-6 hours, in blood for up to 24 hours, in saliva for up to 1 day, and in hair for up to 90 days. Additionally, a multitude of personal factors like age, chronic illness, body mass, hydration, and metabolism can all impact how long naltrexone lasts in your system.

No.

No. Naltrexone is not addictive. Taking naltrexone is not “substituting one addiction for another.” Unlike some medications, there is no potential for abuse.

All medications have the risk of side effects. However, the side effects of naltrexone are rare and usually mild; the most common is nausea. To minimize the risk of side effects, Oar's clinical experts recommend ramping up to a full 50mg dose over one week. You can start by taking 25 mg (half a dose) with a meal each day. Then, you can take a split dose. This means taking half of a pill with one meal (like breakfast) and half of a pill with another meal (like dinner). Finally, you can take a full 50mg pill with a meal. If you are prescribed naltrexone and experience side effects, you can follow up with your Oar medical provider to address the issue. In some cases, your medical provider may find it appropriate to adjust your dosage or the method in which you take your medication to reduce any symptoms you may be experiencing. To learn more about potential side effects of naltrexone, consult our Reference Library. And to connect with a provider who can determine whether naltrexone is medically appropriate for you, complete an online assessment.

Yes. Naltrexone gives you options. The medication is an effective option for both people who want to remain abstinent from alcohol and those who just want to drink less. While some patients use naltrexone to help them stop drinking entirely and avoid alcohol relapse, many others find that naltrexone helps them drink in moderation. Naltrexone does not react adversely with alcohol, so it is safe to drink alcohol in moderation while taking naltrexone. Some patients, with the guidance of a medical provider, intentionally take naltrexone only one to two hours before they know they will have a drink (sometimes referred to as “The Sinclair Method”). Whether your goal is to remain abstinent from alcohol or just manage your relationship with alcohol, it’s important to follow your medical provider's guidance should you be prescribed the medication.

No. Naltrexone is not an opiate. In fact, naltrexone is an opioid antagonist, meaning it binds to opioid receptors in the brain, blocking the effect of opioids.

Yes, a daily dose of naltrexone works in few hours and throughout that same day. When starting naltrexone treatment, your experiences with alcohol are likely to noticeably change within the first few weeks on naltrexone. This can mean fewer cravings for alcohol, fewer thoughts about alcohol, alcohol, less interest in daily drinking, reduced appeal of alcohol, and less interest in heavy drinking.

Taking 25mg naltrexone is not considered an effective dose for the treatment of Alcohol Use Disorder and has not been well studied. That said, some people may find maintaining on a 25mg dose lowers the risk of side effects and still helps control or eliminate drinking. Oar's clinical experts recommend ramping up to a full 50mg dose over one week. You can start by taking 25 mg (half a dose) with a meal each day. Then, you can take a split dose. This means taking half of a pill with one meal (like breakfast) and half of a pill with another meal (like dinner). Finally, you can take a full 50mg pill with a meal.

Great question. The short answer: naltrexone is greatly underprescribed. To learn more about some of the key reasons you may not be familiar with pharmacotherapy as a treatment for AUD, consult our Reference Library.

Naltrexone can be taken daily or only before drinking. Long-term treatment is most effective.  Some patients take naltrexone every day. Others take it only before drinking, following the Sinclair Method. Oar's clinical experts recommend taking naltrexone for at least one year.

Naltrexone can hep some people drink less or quit alcohol entirely without other formal treatment. Naltrexone is also compatible with other forms of treatment, such as mutual peer support groups (like Alcoholics Anonymous, Moderation Management, and SMART Recovery) and professional behavioral healthcare (like a therapist, coach or counselor).

There is no one-size-fits-all answer when it comes to treating Alcohol Use Disorder.

We love to share our sources, so click through our Reference Library for more resources, peer-reviewed studies, and articles on naltrexone, Alcohol Use Disorder, and more.

After you complete your online assessment, you can also message your personal Oar provider any questions you may have via your patient portal. And of course, you can reach out to the Oar team with your questions any time via support@oarrx.com.