Can naltrexone (opioid receptor antagonist) be used with alcohol?

Naltrexone and Alcohol Use: Safety and Efficacy

Naltrexone can be safely used with alcohol and is actually FDA-approved for the treatment of alcohol dependence, helping to reduce alcohol cravings and prevent relapse in patients with alcohol use disorder. 1

Mechanism and Efficacy

Naltrexone is a pure opioid receptor antagonist that works by:

• Blocking opioid receptors, which may reduce the rewarding effects of alcohol
• Decreasing alcohol cravings through modulation of the endogenous opioid system
• Reducing the risk of relapse to heavy drinking 2, 3

Clinical trials have demonstrated that naltrexone:

• Reduces relapse rates (31% vs 60% with placebo) 1
• Decreases the number of drinking days 1
• Lowers alcohol craving 1
• Is most effective when combined with psychosocial interventions 3

Dosing and Administration

• Standard dosing is 50 mg once daily 1
• Can be administered as:
  • Oral tablets (daily administration)
  • Long-acting injectable formulation (monthly administration) for patients with adherence concerns 3
• Treatment duration is typically 3-12 months, though optimal duration is not well established 3

Monitoring and Safety Considerations

Liver Function

• Naltrexone has been shown to cause hepatocellular injury in some patients 2
• Monitoring of liver function tests is recommended every 3-6 months 3
• Use with caution in patients with existing liver disease, though it remains an option for patients with alcoholic liver disease 2, 3

Compliance

Treatment efficacy is significantly improved with good medication adherence and participation in psychosocial interventions 3, 1

Combination with Other Interventions

For optimal outcomes, naltrexone should be combined with:

• Psychosocial interventions such as cognitive behavioral therapy or motivational interviewing 3
• Nutritional support and vitamin supplementation, particularly B vitamins 3
• Regular follow-up to monitor for side effects and ensure compliance 3

Common Side Effects

• Nausea (most common) 4
• Headache
• Dizziness
• Fatigue
• Anxiety
• Insomnia

Important Distinctions

Unlike disulfiram, naltrexone:

• Does not cause an aversive reaction when alcohol is consumed 1
• Works by reducing cravings rather than creating negative associations 3, 1

Contraindications

• Current use of opioid analgesics
• Acute opioid withdrawal
• Failed naloxone challenge test
• Acute hepatitis or liver failure

Clinical Pearls

• Naltrexone is not a substitute for abstinence but rather an aid to reduce drinking and support abstinence 2
• It is most effective when patients are already abstinent at the start of treatment 3
• Men may show greater treatment response than women in some studies 5
• Patients should be informed that naltrexone will block the effects of any opioid medications, which is important in case emergency pain management is needed 1

Naltrexone represents an evidence-based pharmacological option for patients with alcohol use disorder, with demonstrated efficacy in reducing heavy drinking and supporting abstinence when combined with appropriate psychosocial interventions.