Can You Drink on Naltrexone? What To Expect and How To Do It Safely

Medically reviewed by Joseph Volpicelli, MD, PhD

If you've recently started naltrexone or you're thinking about it, you probably have questions. Specifically, can you drink on naltrexone? The answer is more nuanced than a simple yes or no, and understanding it fully can make a real difference in your treatment success.

Here's what you need to know.

What Naltrexone Does

Naltrexone is an FDA-approved, opioid antagonist medication that has been used to treat alcohol use disorder (AUD) since 1994. It works by binding to the brain's opioid receptors and blocking the rewarding effects, “buzz”, people associate with alcohol.   

When alcohol no longer produces the same rewarding sensation, people are better able to reduce their drinking, and cravings often decrease. Over time, many people find it significantly easier to drink less or stop altogether.

So, Is It Safe To Drink on Naltrexone?

This is where the "it depends" comes in. Drinking on naltrexone is not medically dangerous in the same way that, say, drinking on certain antibiotics or sedatives can be. Research consistently shows no significant or harmful interactions between naltrexone and alcohol at standard doses. Alcohol damages the liver, but for most people there is no increased risk of liver damage if you add naltrexone. At prescribed doses. Naltrexone has maintained a strong safety profile for the treatment of AUD for over 30 years.

That said, safe is not the same as consequence-free. A few important points to keep in mind:

• Alcohol still impairs you.
• Nausea can increase.

Your goals still guide your choices. For patients pursuing abstinence, drinking while on naltrexone works against the treatment plan. For those following targeted dosing (The Sinclair Method, more on that below), drinking with naltrexone is part of treatment. The right approach depends on what you and your prescribing clinician have decided together.

What To Expect When You Drink on Naltrexone

Can you drink on naltrexone at 50 mg? Most people who drink alcohol on naltrexone at this dosage notice a distinct shift in how alcohol feels. The familiar rewarding sensation fades. That pull toward a second drink is weaker. Some describe it as drinking feeling flat or purposeless. For many people in treatment for AUD, that's exactly the point.

Here's what the experience typically looks like:

• Reduced euphoria. Alcohol may feel less pleasurable than usual. 
• Fewer cravings mid-session. For many people, drinking alcohol increases the craving for more. Naltrexone interrupts this loop, so people are often satisfied after just one or two drinks. 
• Normal intoxication. Balance, coordination, and reaction time are still impaired by alcohol, even though the pleasurable feelings are reduced.

It's worth noting: naltrexone does not make you sick when you drink. That's disulfiram (Antabuse), a different medication entirely. Naltrexone simply removes the reward; it doesn't create a punishing reaction.

The Sinclair Method: Drinking With Naltrexone as the Strategy

The Sinclair Method (TSM) is a specific treatment protocol built around intentional drinking on naltrexone. Developed by neuroscientist Dr. John David Sinclair, TSM asks patients to take naltrexone approximately one to two hours before drinking, every single time they drink. The goal is pharmacological extinction: by repeatedly pairing alcohol with a blocked reward response, the brain gradually unlearns the association between drinking and feeling good.

Over time, cravings lessen. Consumption decreases. Some people eventually stop drinking entirely without ever formally trying to quit.

If you're following TSM with Oar Health, a few things are critical:

• The one-hour rule matters. Naltrexone needs time to reach an adequate concentration in your bloodstream before it can effectively block alcohol's effects. Taking it right before your first drink undermines the entire mechanism.
• Consistency is everything. Skipping naltrexone on a drinking day allows the reward pathway to fire unblocked, which reinforces, rather than extinguishes, the drive to drink.

TSM is not a license to drink freely. The goal is extinction, not perpetual maintenance. Alcohol still causes real physical harm over time, and responsible consumption during TSM is part of the protocol.

Naltrexone Dosing and Timing: What You Should Understand

The standard oral dose of naltrexone is 50 mg, typically taken once daily. Some clinicians may start patients at 25 mg for a few days to allow the body to adjust and reduce the likelihood of initial side effects.

For daily dosing in an abstinence-focused approach, timing is more flexible; many people take it in the morning. For TSM, timing is specific: one hour before any anticipated drinking.

Do not adjust your dose without speaking to your clinician. If you're experiencing side effects or if you feel the medication isn't producing the expected reduction in cravings, that's a conversation for your healthcare provider, not something to manage by increasing or decreasing your dose independently.

Common Side Effects To Know

Most people tolerate naltrexone well, but side effects do occur, particularly in the early weeks of treatment. The most frequently reported include:

• Nausea and stomach upset (most common, often resolves in first 2 weeks)
• Headache
• Fatigue or tiredness
• Dizziness
• Decreased appetite
• Muscle or joint discomfort

Serious side effects are uncommon at standard doses. If you experience significant abdominal pain, yellowing of the eyes or skin, or unusual fatigue, contact your prescribing clinician promptly, as these can be signs of liver damage, particularly relevant for patients who have a history of liver disease.

When To Talk to Your Healthcare Provider

Your experience with naltrexone can vary depending on your treatment plan, drinking pattern, medical history, and goals. Check in with your healthcare provider if:

• Your cravings or drinking haven't improved after several weeks of taking naltrexone as prescribed
• You're still drinking more than you intend to or having difficulty stopping once you start
• Side effects are persistent or interfering with daily life
• You need opioid pain medication or have recently used opioids. Naltrexone blocks opioid effects, and starting it too soon after regular opioid use can trigger withdrawal

At Oar Health, the clinical team can help you work through these questions and adjust treatment when needed. Whether your goal is to drink less or stop drinking altogether, treatment should be tailored to your goals, response, and medical needs.

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Frequently Asked Questions

Can you drink alcohol the same day you take naltrexone if you're on an abstinence-based plan?

Naltrexone won't cause a dangerous reaction if you drink, but drinking while on an abstinence-focused plan undermines the treatment goals you developed with your clinician. It's best to talk with your provider honestly if you've been drinking. Adjusting the approach is far more productive than stopping the medication.

Does naltrexone interact with any other common medications or supplements?

The most clinically significant interaction is with opioid-based medications. Naltrexone will block their effects and can trigger precipitated withdrawal if opioids are in your system. It does not interact with common over-the-counter pain relievers like ibuprofen or acetaminophen. Always give your full medication list to any prescribing clinician.

Will naltrexone show up on a drug test?

Naltrexone itself is not a controlled substance and is not typically screened for in standard workplace drug panels. However, because it is an opioid antagonist, it may cause a false positive on certain opioid screens. If an opioid screening test is unexpectedly positive, a more specific confirmatory test can usually determine whether an opioid was actually present. If you are undergoing drug testing, tell the clinician or testing facility that you take naltrexone.

This article was medically reviewed by Joseph Volpicelli, MD, PhD, a Senior Adviser to Oar Health whose research established naltrexone as a treatment for alcohol use disorder. Review confirms the clinical information here was accurate and current as of October 16, 2026. It is not a substitute for advice from your own clinician.