Naltrexone: Definition, Mechanism of Action, Uses, Dosage, Side Effects, Alternatives

Naltrexone is a medication approved by the Food and Drug Administration (FDA) to treat both opioid and alcohol use disorders. This helps individuals reduce their dependence on these substances.

The primary uses of naltrexone are in the management of opioid use disorder (OUD) and alcohol use disorder (AUD). By mitigating cravings and the pleasurable effects of these substances, naltrexone supports individuals in their recovery efforts.

The standard dosage for naltrexone varies based on the condition being treated. For AUD, the typical oral dosage is 50 mg once daily. For OUD, an extended-release intramuscular injection of 380 mg is administered monthly. The Substance Abuse and Mental Health Services Administration (SAMHSA) supports these recommendations.

Common side effects of naltrexone include nausea, headaches, dizziness, and fatigue. More moderate adverse effects involve sleep disturbances and anxiety. According to a study “LiverTox: Clinical and Research Information on Drug-Induced Liver Injury” published by the National Institute of Health (NIH), serious side effects encompass liver damage, necessitating regular monitoring of liver function during treatment.

Alternative treatments for OUD (opioid use disorder) include medications such as methadone and buprenorphine, which act on opioid receptors to alleviate withdrawal symptoms and cravings. For AUD (alcohol use disorder), alternatives like acamprosate and disulfiram are available, each with distinct mechanisms to support abstinence and recovery.

What Is the Definition of Naltrexone?

Naltrexone is an opioid antagonist that binds to opioid receptors in the brain, effectively blocking the effects of opioids and diminishing the rewarding sensations associated with alcohol consumption. This mechanism aids in reducing cravings and supports recovery efforts for individuals dealing with opioid use disorder (OUD) and alcohol use disorder (AUD). A meta-analysis “Pharmacotherapy for Alcohol Use Disorder” by Melissa McPheeters, et al. 2023, revealed that oral naltrexone (50 mg/day) led to a statistically significant 19% reduction in the risk of returning to heavy drinking compared to placebo. This corresponds to a number needed to treat (NNT) of 11, indicating that for every 11 individuals treated with naltrexone, one person benefits by avoiding a return to heavy drinking. 

Unlike some treatments, naltrexone does not cause dependence, making it a non-addictive option in medication-assisted therapy for these conditions. Common brand names for naltrexone include Revia, Vivitrol, and Depade.

How Is Naltrexone Administered?

Naltrexone is consumed as a daily oral tablet or as a long-acting monthly injection, offering flexibility in treatment approaches. The oral form, known by the brand name ReVia, requires daily administration, which demands consistent adherence to maintain its effectiveness. In contrast, the injectable form, marketed as Vivitrol, is administered as a 380 mg intramuscular injection every four weeks, providing a sustained release that enhances adherence by reducing dosing frequency. ​

• Oral tablet (ReVia):
  • Dosage: 50 mg taken once daily.​
  • Administration: Self-administered orally.​
  • Adherence: Requires daily commitment to maintain therapeutic levels.

• Intramuscular injection (Vivitrol):
  • Dosage: 380 mg administered once every four weeks.
  • Administration: Performed by a healthcare professional via intramuscular injection.​
  • Adherence: Monthly dosing improves adherence compared to daily oral intake.

The choice between oral and injectable forms is based on individual patient needs, preferences, and the likelihood of adherence to the treatment regimen. Consulting with a healthcare provider helps determine the most appropriate form of naltrexone for each individual.

How Is Naltrexone Manufactured?

Naltrexone is manufactured through a chemical process that begins with noroxymorphone, a derivative of thebaine, an alkaloid found in opium poppies. Noroxymorphone undergoes alkylation with a cyclopropylmethyl halide in the presence of N-methyl-2-pyrrolidone (NMP) and controlled amounts of water, resulting in naltrexone. This method has been optimized to achieve high purity and yield, making it suitable for large-scale industrial production.

How Does Naltrexone Work for Addiction Treatment?

Naltrexone works for Addiction Treatment as an opioid receptor antagonist, primarily targeting mu-opioid receptors through competitive binding. This action inhibits the effects of endogenous opioids, leading to a reduction in dopamine release within the brain’s reward pathways, which diminishes the reinforcing effects of addictive substances. The medication has an elimination half-life of 4 hours, with its active metabolite, 6-β-naltrexol, exhibiting a half-life of 13 hours. Following oral administration, naltrexone is rapidly and nearly completely absorbed, achieving peak plasma concentrations within one hour. The blockade of opioid receptors persists beyond the presence of the drug in plasma, contributing to its efficacy in addiction treatment. ​

Why Is Naltrexone Used in MAT?

Naltrexone is used in medication-assisted treatment (MAT) for both opioid addiction and alcohol use disorder. Medication-assisted treatment (MAT) combines FDA-approved medications with various behavioral therapies for addiction treatment. Naltrexone, as an opioid receptor antagonist, binds to opioid receptors in the brain, blocking the euphoric and sedative effects of substances like heroin and alcohol. This mechanism of Medication Assisted Treatment (MAT) aids in relapse prevention by reducing cravings and diminishing the rewarding sensations associated with substance use. 

Unlike some other treatments, naltrexone is non-addictive and does not lead to physical dependence.​

Effectiveness in Opioid Use Disorder (OUD):

• Long-acting injectable naltrexone decreases heroin use compared to a placebo primarily due to its ability to block the euphoric effects of opioids and improve treatment adherence by providing a sustained release mechanism with less frequent injections. According to a study “Long-Acting Injectable Naltrexone for the Management of Patients with Opioid Dependence” by Kimberly L Kjome, et al. 2011, found that Opioid positive urines at 6 months were lowest in the naltrexone implant group (63%), and higher in the oral naltrexone and placebo trials (87 and 86%, respectively).

Effectiveness in Alcohol Use Disorder (AUD):

• Naltrexone reduces the quantity and frequency of alcohol consumption by diminishing the dopamine release associated with drinking. According to a study “Naltrexone for the Management of Alcohol Dependence” by Raymond F Anton, 2009, found that Naltrexone is an agent that blocks opioid receptors, particularly the μ-opioid receptor. The use of this agent in animal models leads to a reduction of dopamine levels in the nucleus accumbens 12-14 and a reduction in alcohol intake.

Incorporating naltrexone into MAT programs, alongside counseling and behavioral therapies, enhances its effectiveness in supporting individuals on their path to recovery from opioid and alcohol dependence.

Is Naltrexone Used for Withdrawal Symptoms During Detox?

No, naltrexone is not used to manage withdrawal symptoms during detox. Administering naltrexone to individuals who are currently dependent on opioids precipitates acute withdrawal symptoms. Therefore, patients must undergo a complete detoxification and remain opioid-free for a period of 7 to 10 days, before initiating naltrexone treatment. This protocol ensures that naltrexone is safely and effectively utilized as part of a comprehensive treatment plan for opioid use disorder, focusing on relapse prevention rather than withdrawal management.​

How Is Naltrexone Combined with Cognitive Behavioral Therapy for Addiction Treatment?

Naltrexone combined with CBT for addiction treatment for alcohol addiction treatment has been shown to enhance treatment outcomes for individuals. Naltrexone, an opioid receptor antagonist, reduces cravings and diminishes the rewarding effects of alcohol, while cognitive behavioral therapy (CBT) equips individuals with coping strategies to manage triggers and prevent relapse.

A study “Naltrexone Effective in Treatment of Alcoholism” by Anton et al. (1999) demonstrated that participants receiving both naltrexone and CBT experienced fewer drinking days, delayed relapse onset, and increased periods between relapses compared to those receiving placebo and cognitive behavioral therapy (CBT). It has shown that 62% of participants receiving both naltrexone and CBT did not relapse into heavy drinking, compared to 40% in the placebo plus CBT group. 

Another study “Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence” by Anton et al. (2005) found that participants receiving naltrexone combined with CBT had higher abstinence rates (80.6%) compared to those receiving placebo with medical management alone (75.1%). ​This combination therapy also improved participants’ control over alcohol-related thoughts and urges, suggesting a synergistic effect between naltrexone and CBT in treating alcohol dependence.

What Is the Recommended Dosage for Naltrexone?

The recommended dosage of naltrexone is 50 mg once daily, for alcohol dependence and in the case of opioid use disorder, naltrexone is administered as an intramuscular injection of 380 mg once every four weeks. These dosages are generally fixed; however, adjustments are necessary based on individual patient factors, such as liver function. It is essential to consult with a healthcare provider to determine the appropriate dosage and to monitor for potential side effects. ​

What Is the Difference Between Oral Naltrexone and the Vivitrol Injection?

The difference between oral naltrexone and the Vivitrol injection lies in their administration methods, dosing schedules, adherence requirements, and cost considerations. Oral naltrexone is taken as a 50 mg tablet once daily, requiring individuals to maintain a consistent daily routine to ensure effectiveness. In contrast, Vivitrol is an extended-release injectable form of naltrexone, administered as a 380 mg intramuscular injection once every four weeks by a healthcare professional. ​

The daily dosing of oral naltrexone necessitates strong adherence, as missing doses compromise treatment outcomes. Vivitrol’s monthly injection schedule enhances adherence by reducing the frequency of dosing and eliminating the need for daily medication intake. ​

Cost is another differentiating factor. Vivitrol is generally more expensive than oral naltrexone. The higher cost of Vivitrol is a consideration for individuals and healthcare providers when determining the most appropriate treatment option.

Both forms of naltrexone are used in medication-assisted treatment for opioid and alcohol use disorders, and the choice between them is based on individual patient needs, lifestyle considerations, and financial factors. Consulting with a healthcare provider helps determine the most suitable form of naltrexone for each individual.

What Are the Side Effects of Naltrexone?

The side effects of naltrexone include nausea and headache, insomnia and anxiety, and liver damage. Naltrexone is an opioid receptor antagonist used in the treatment of alcohol and opioid dependence and is associated with various side effects that differ in frequency and severity. 

Common side effects of naltrexone include:

• Nausea and/or vomiting: Many individuals report feelings of sickness or actual vomiting. According to a study “The safety profile of naltrexone in the treatment of alcoholism.” by R S Croop, et al., published by the National Institutes of Health (NIH) report that 9.8% of patients report experiencing nausea. ​
• Headache: Head pain or migraines are frequently experienced. According to the same study, 6.6% of individuals experience headaches. ​

Moderate side effects of naltrexone include:

• Insomnia or sleep disturbances: Some individuals report difficulty sleeping, as reported by a study “SIde effects of naltrexone oral tablets” by Medical News Today.
• Anxiety or nervousness: Feelings of anxiety have been observed in certain cases. ​
• Abdominal pain or cramps: Some patients experience discomfort in the abdominal area. ​
• Joint and muscle pain: Musculoskeletal discomfort has been reported by some users.

Severe side effects of naltrexone include:

• Liver damage: High doses of naltrexone have been associated with liver injury. According to the U.S. Food and Drug Administration, it is recommended to monitor liver function before and during treatment.
• Injection site reactions: For those receiving the intramuscular form (Vivitrol), reactions at the injection site, such as pain, swelling, or infection, occur.

Can You Have Withdrawal Symptoms When Stopping Naltrexone?

No, discontinuing naltrexone does not cause withdrawal symptoms, as it is not an addictive substance. However, if naltrexone is administered to individuals who still have opioids in their system, it precipitates acute withdrawal by displacing opioids from their receptors. A study “Withdrawal syndrome caused by naltrexone in opioid abusers” by Hassanian-Moghaddam et al., involving 132 patients reported that 96.2% experienced agitation, 38.6% had altered levels of consciousness, 28% experienced nausea, 27.3% had vomiting, 24.2% reported abdominal pain, 16.7% experienced diarrhea, 15.9% had bone and muscle pain, 12.9% experienced tachycardia, and 11.4% had dilated pupils.

These findings highlight the importance of ensuring that patients have been opioid-free for an appropriate period before initiating naltrexone treatment to minimize the risk of precipitated withdrawal.

How Long Does Naltrexone Stay in Your System?

Naltrexone stays in your system for 4 to 6 hours. For oral naltrexone, the drug has a half-life of 4 hours, meaning it takes about 4 hours for half of the drug to be eliminated from the body. However, its active metabolite, 6β-naltrexol, has a longer half-life of 13 hours. In contrast, the extended-release injectable form, known as Vivitrol, has a longer half-life, ranging from 5 to 10 days. This means that naltrexone from the injection remains in the system for several weeks.

Regarding detection in drug tests, naltrexone is not included in standard drug screening panels. Specialized tests are required to detect its presence, and the detection window depends on the sensitivity of the test and the formulation used.

What Happens If You Stop Naltrexone Cold Turkey?

Relapse happens when you stop naltrexone cold turkey. It does not cause withdrawal symptoms, as naltrexone is not an addictive substance. However, discontinuing its use increases the risk of relapse into opioid or alcohol use. For example, a study “Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans” by Anne E Leighty, et al. 2019, comparing long-acting injectable (LAI) naltrexone to oral naltrexone in veterans with alcohol use disorder found that the median time to relapse was longer for those treated with LAI naltrexone (150.5 days) compared to those on oral naltrexone (50.5 days).

Therefore, it is recommended to consult a healthcare provider before making any changes to naltrexone treatment to ensure appropriate support and minimize relapse risk.

Does Naltrexone Need to Be Tapered?

No, naltrexone does not need to be tapered because naltrexone is not an opioid and does not cause physical dependence, therefore, stopping it abruptly does not lead to withdrawal symptoms. However, it is important to consult with a healthcare provider before discontinuing naltrexone, as stopping the medication increases the risk of relapse into opioid or alcohol use.

What Are the Alternatives to Naltrexone?

Yes, the alternatives of naltrexone are Buprenorphine, Methadone, Acamprosate, Disulfiram (Antabuse), Topiramate, and Gabapentin. Each of these medications offers unique benefits and is chosen based on individual patient needs, medical history, and specific addiction profiles. 

The alternatives to naltrexone are as follows:

• Buprenorphine: A partial opioid agonist that activates opioid receptors to a lesser degree, reducing cravings and withdrawal symptoms without producing the full euphoria associated with opioids. This makes it effective in opioid use disorder treatment. A Study “Opioid Use Disorder: Medical Treatment Options” by DIANA COFFA, et al. 2019, indicates that buprenorphine, when provided in dosages of at least 16 mg per day, is as effective as methadone in reducing illicit opioid use and improving treatment retention.
• Methadone: A full opioid agonist that activates opioid receptors, reducing cravings and withdrawal symptoms. It is administered under supervision in specialized clinics due to its potency and risk of misuse. The research titled “Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder” by Sarah E. Wakeman, et al. 2020, shows that methadone treatment is associated with a 53% reduction in the risk of overdose at 12 months compared to no medication treatment.
• Acamprosate: A medication that stabilizes brain chemistry altered by alcohol dependence, reducing the risk of relapse among alcohol-dependent individuals.
• Disulfiram (Antabuse): A medication that interferes with the metabolism of alcohol, leading to unpleasant effects when alcohol is consumed, thereby deterring individuals from drinking. ​
• Topiramate: An anticonvulsant that has shown promise in reducing alcohol consumption and promoting abstinence in individuals with alcohol use disorder. ​
• Gabapentin: Explored for its potential in treating alcohol use disorder. ​According to a study “Treatment of substance use disorders in patients with chronic liver disease” by Manisha Verma, et al. 2022, it is an anticonvulsant that helps reduce alcohol cravings and withdrawal symptoms.

Consultation with a healthcare provider is essential to determine the most appropriate treatment option.

How Does Naltrexone Differ from Suboxone?

Naltrexone differs from Suboxone in its mechanisms of action and associated dependence risks. Naltrexone is an opioid antagonist, meaning it binds to opioid receptors without activating them, thereby blocking the effects of opioids and preventing any euphoric sensations. Consequently, naltrexone carries no risk of abuse or physical dependence. In contrast, Suboxone combines buprenorphine, a partial opioid agonist, with naloxone, an opioid antagonist. Buprenorphine activates opioid receptors to a lesser degree, reducing cravings and withdrawal symptoms without producing the full euphoria associated with opioids.

However, because buprenorphine still stimulates opioid receptors, there remains a risk, albeit lower, of dependence compared to full agonists. The inclusion of naloxone in Suboxone serves as a deterrent to intravenous misuse, as it precipitates withdrawal symptoms if injected.

What Is the Difference Between Naltrexone and Methadone?

Naltrexone and methadone differ in their mechanisms of action and potential for dependence. Naltrexone is an opioid antagonist that binds to opioid receptors without activating them, thereby blocking the effects of opioids and preventing any euphoric sensations. Consequently, naltrexone carries no risk of abuse or physical dependence. In contrast, methadone is a full opioid agonist that activates opioid receptors, reducing cravings and withdrawal symptoms by producing effects similar to other opioids, though less intense. However, because methadone stimulates opioid receptors, there is a risk of dependence and potential for misuse. Additionally, methadone must be dispensed through specialized clinics, whereas naltrexone is prescribed by qualified physicians and mid-level practitioners in various healthcare settings, offering more convenience for patients.

Who Should Not Take Naltrexone?

Naltrexone should not be taken by individuals currently using opioids, those with acute hepatitis or liver failure, and pregnant women. These individuals need to consult with a healthcare provider before starting naltrexone to ensure it is safe and appropriate for their specific medical conditions.

According to the U.S. Food and Drug Administration (FDA), individuals who should not take naltrexone include:​

• Current opioid users: Administering naltrexone to individuals actively using opioids precipitates acute withdrawal symptoms.
• Patients with acute hepatitis or liver failure: Naltrexone has been associated with liver damage, particularly at higher-than-recommended doses; therefore, it should not be used in patients with liver conditions.
• Pregnant women: The safety of naltrexone during pregnancy has not been established, making its use inadvisable for pregnant women.

Can You Use Naltrexone If You Are Using Opioids?

No, naltrexone cannot be used if opioids are still present in your system. Administering naltrexone under these conditions precipitates acute withdrawal by displacing opioids from their receptors. Therefore, it is essential to complete opioid detoxification, requiring 7–10 days of abstinence, before starting naltrexone treatment.

How Does Naltrexone Work for Alcohol Addiction Treatment?

Naltrexone works as an opioid receptor antagonist that reduces the rewarding effects of alcohol consumption by blocking endogenous opioids released during drinking. This action diminishes the results of alcohol rehab and detox and the pleasurable sensations associated with alcohol intake, leading to decreased cravings and a lower risk of relapse in individuals with alcohol dependence.

Can you Get Naltrexone Over the Counter?

Yes, you need a doctor’s prescription for naltrexone in the U.S., it is not available over the counter. Naltrexone is a prescription medication in the United States, utilized for treating alcohol and opioid use disorders. It is not available over the counter and requires a prescription from a licensed healthcare provider. The Food and Drug Administration (FDA) has approved naltrexone for some specific uses, and it is prescribed and administered by any practitioner licensed to prescribe medications. Proper medical oversight is a must to ensure the safety and effectiveness of naltrexone treatment. Consulting a licensed healthcare provider is necessary to obtain this medication. ​

Is It Safe to Use Naltrexone Long-Term?

Yes, long-term use of naltrexone is considered safe. However, regular monitoring of liver function is recommended, as naltrexone has been associated with liver damage, particularly at higher-than-recommended doses. A Study “The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain” by Jarred Younger, et al. 2014, has shown that most individuals tolerate long-term naltrexone therapy well, with minimal adverse effects.

How Does Naltrexone Compare to Disulfiram?

Naltrexone compares to disulfiram in that they are both approved medications for treating alcohol use disorder, but they differ in their mechanisms of action and effectiveness. Naltrexone, an opioid receptor antagonist, reduces the rewarding effects of alcohol, thereby diminishing cravings and consumption. Disulfiram inhibits acetaldehyde dehydrogenase, causing unpleasant reactions when alcohol is consumed, thus deterring intake. A study “The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain” by Jarred Younger, et al. 2014, comparing these medications found that both reduced alcohol craving and intake significantly over 12 weeks. However, naltrexone was better tolerated, while disulfiram had a lower treatment dropout rate.

Another study “A one-year pragmatic trial of naltrexone vs disulfiram in the treatment of alcohol dependence” by Alan De Sousa, et al. 2004, observed that disulfiram was more effective in preventing relapse among alcohol-dependent men with family support, whereas naltrexone was associated with lower craving levels. These findings suggest that while both medications are effective, individual patient factors and support systems influence their treatment success.​

Does Naltrexone Work for All Addictions?

No, naltrexone does not work for all addictions. It is primarily effective in treating alcohol use disorder and opioid use disorder by blocking the euphoric effects of these substances, thereby reducing cravings and consumption. However, its efficacy in treating other addictions, such as nicotine or stimulant dependence, has not been established. Therefore, naltrexone is not considered an effective treatment for all types of addiction.

Should I take Naltrexone While Pregnant or Breastfeeding?

No, you should not take naltrexone during pregnancy and breastfeeding. Naltrexone is classified as a Category C medication for pregnancy, indicating that risk to the fetus is not ruled out. Initiating naltrexone treatment during pregnancy is generally not recommended, especially for individuals currently using opioids, as it requires complete detoxification, which carries risks for both the mother and fetus. However, According to the Substance Abuse and Mental Health Service Administration, women who become pregnant while stabilized on naltrexone continue its use under close medical supervision, weighing the potential benefits against the risks.

A study “Naltrexone Treatment for Pregnant Women With Opioid Use Disorder” by Elisha M Wachman, et al. 2019, reported that 83% of women on naltrexone breastfed without immediate issues in the perinatal period. Naltrexone has been detected in breast milk in a single case study, with the infant receiving less than 1% of the maternal dose. However, further research is necessary to make definitive recommendations about its safety during breastfeeding.

The use of naltrexone during pregnancy and breastfeeding involves careful consideration and consultation with healthcare providers to assess potential risks and benefits.

Will Naltrexone Show up on a Drug Test?

No, Naltrexone does not show up on standard drug tests, which are designed to identify substances commonly associated with misuse, such as opioids, cannabinoids, and amphetamines. However, specialized tests detect naltrexone and its metabolites if necessary. Notably, there have been instances where naltrexone use has led to false-positive results for oxycodone in urine drug screens due to the presence of its metabolite, noroxymorphone.

A study “Opioid-positive urine drug screen during treatment with oral naltrexone and the clinical implications” by Elena R Beauregard, et al. 2024, reports that confirmatory testing using more specific methods, like gas chromatography-mass spectrometry, is essential to accurately identify the substances present and avoid misinterpretation.

What Is the Difference Between the Oral Form of Naltrexone and the Vivitrol Injection?

The difference between the oral form of naltrexone and the Vivitrol injection lies in their administration methods, dosing schedules, pharmacokinetics, and patient adherence considerations. Oral naltrexone is taken daily, requiring consistent patient compliance to maintain therapeutic effectiveness. In contrast, Vivitrol, an extended-release injectable form, is administered once monthly, providing sustained medication levels without the need for daily dosing. This monthly injection bypasses first-pass metabolism in the liver, resulting in a reduced total monthly dose compared to daily oral administration.

Clinical studies like “Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans” by Anne E Leighty, et al. 2019, have shown that patients receiving Vivitrol have longer median times to relapse compared to those on oral naltrexone, suggesting improved efficacy in preventing relapse. However, the cost of Vivitrol is significantly higher than that of oral naltrexone, which influences treatment decisions. Ultimately, the choice between these formulations is based on individual patient needs, considering factors such as the ability to adhere to daily medication regimens, financial considerations, and potential side effects.​

Can Naltrexone Be Taken While Still Drinking Alcohol?

​Yes, naltrexone can be initiated while a person is still consuming alcohol; however, starting the medication after achieving abstinence enhances its effectiveness and reduces potential side effects. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), patients are not physically dependent on alcohol or other substances when starting naltrexone to avoid strong side effects such as nausea and vomiting. Additionally, a meta-analysis by Natalya C Maisel, et al. 2012 indicated that requiring abstinence before initiating naltrexone treatment was associated with larger effect sizes for maintaining abstinence and reducing heavy drinking compared to placebo. Therefore, while naltrexone started during ongoing alcohol consumption, initiating treatment after a period of abstinence improves outcomes and minimizes adverse effects.​

Can Naltrexone Be Used to Treat Co-occurring Disorders?

Yes, naltrexone can be used to treat certain co-occurring disorders, though its effectiveness varies depending on the specific conditions involved. Primarily approved by the U.S. Food and Drug Administration (FDA) for treating alcohol use disorder (AUD) and opioid use disorder (OUD), naltrexone has been explored for other co-occurring conditions with mixed results.​

For individuals with co-occurring AUD and post-traumatic stress disorder (PTSD), the study “Pharmacotherapy for Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder” by Terril L Verplaetse, et al. 2018, has shown that naltrexone modestly reduces alcohol cravings and consumption. However, its impact on PTSD symptoms appears limited. A review “A double-blind, placebo-controlled trial combining sertraline and naltrexone” by Helen M Pettinati, et al. 2010, highlighted that while naltrexone effectively addresses alcohol use outcomes, its efficacy in alleviating PTSD symptoms remains uncertain.

In cases of co-occurring AUD and major depressive disorder (MDD), combining naltrexone with antidepressants like sertraline has demonstrated promising results. A double-blind, placebo-controlled trial found that the combination of sertraline and naltrexone led to higher alcohol abstinence rates and extended time before relapse into heavy drinking compared to either medication alone or placebo.

Regarding co-occurring AUD and cocaine use disorder, research indicates that naltrexone’s efficacy is limited. A study “Naltrexone treatment of comorbid alcohol and cocaine use disorders” by D Hersh, et al. involving subjects with both disorders showed reductions in alcohol and cocaine consumption across all participants, but there was no consistent advantage of naltrexone over placebo.

Naltrexone is effective for treating OUD and AUD, its utility in managing co-occurring disorders depends on the specific conditions. It shows potential benefits when combined with other treatments for certain co-occurring mental health disorders, but its effectiveness varies. Therefore, treatment plans are individualized, considering the unique needs and conditions of each patient.

Is Naltrexone Addictive?

No, naltrexone is not addictive. It functions as an opioid receptor antagonist, blocking the effects of opioids without activating these receptors, thereby lacking any potential for abuse or dependence. Naltrexone does not produce euphoric effects or lead to physical dependence, making it a non-addictive treatment option for individuals with opioid or alcohol use disorders.