Naltrexone: Clinically Proven to Reduce Alcohol Cravings
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Synonyms | |||
Naltrexone is a prescription medication approved by the FDA for the treatment of alcohol use disorder (AUD). It functions as an opioid receptor antagonist, working to diminish the rewarding effects and cravings associated with alcohol consumption. When integrated into a comprehensive treatment plan that includes counseling and behavioral therapies, Naltrexone provides a scientifically-backed pharmacological approach to support sustained recovery and reduce the risk of relapse. This medication is a cornerstone in modern addiction medicine, offering a targeted neurochemical intervention.
Features
- Active Ingredient: Naltrexone Hydrochloride
- Available Formulations: Oral tablets (50 mg standard) and extended-release intramuscular injection (380 mg/vial)
- Mechanism of Action: Pure opioid antagonist, primarily blocking mu-opioid receptors
- Bioavailability: Oral: 5–40% (extensive first-pass metabolism); Injection: achieves sustained release
- Half-Life: Oral: 4–13 hours; Injection: 5–10 days (depending on release kinetics)
- Metabolism: Primarily hepatic, via dihydrodiol dehydrogenase and subsequent glucuronidation
- Excretion: Primarily renal (urine)
Benefits
- Significantly reduces the subjective euphoric and reinforcing effects of alcohol consumption
- Decreases the frequency and intensity of alcohol cravings, aiding in impulse control
- Supports long-term abstinence and reduces heavy drinking days when used as prescribed
- Integrates effectively with psychosocial interventions for a multimodal treatment approach
- Can help restore neurochemical balance disrupted by chronic alcohol use
- Provides a non-addictive, evidence-based pharmacological option for AUD management
Common use
Naltrexone is indicated for use in adults as part of a comprehensive treatment program for alcohol dependence. It is prescribed for patients who have undergone alcohol detoxification and have achieved initial abstinence, aiming to maintain this state. It is commonly utilized in both outpatient and inpatient settings, often in conjunction with cognitive behavioral therapy (CBT), motivational enhancement therapy, or support group participation like SMART Recovery or 12-step facilitation. It is suitable for patients demonstrating a motivated commitment to reduction or cessation of alcohol intake.
Dosage and direction
The standard initial dosage for oral Naltrexone is 25 mg once daily for the first few days to assess tolerability, typically increasing to the maintenance dose of 50 mg once daily thereafter. It may be taken with or without food, though taking it with food may mitigate potential gastrointestinal discomfort. The extended-release injectable formulation (Vivitrol®) is administered at a dose of 380 mg via intramuscular gluteal injection every four weeks by a healthcare professional. Adherence to the prescribed dosing schedule is critical for therapeutic efficacy. Treatment duration is individualized but often continues for several months to over a year, based on clinical response and patient progress.
Precautions
Patients should be advised that Naltrexone will block the effects of exogenous opioids, rendering opioid analgesics ineffective for pain relief; alternative non-opioid pain management strategies must be planned for. Liver function tests should be performed prior to initiation and periodically during therapy, as the drug is metabolized hepatically. Use with caution in patients with moderate to severe renal impairment. Naltrexone may cause dizziness or sedation; patients should exercise caution when operating machinery or driving until they know how the medication affects them. It is not recommended for use in acute alcohol withdrawal or in patients with active hepatitis or liver failure.
Contraindications
Naltrexone is contraindicated in patients receiving opioid analgesics, those with current physiologic opioid dependence, or those in acute opioid withdrawal. It is also contraindicated in individuals with a history of hypersensitivity to Naltrexone or any component of the formulation. Patients with acute hepatitis or liver failure should not use this medication. Due to the presence of a poly(DL-lactide-co-glycolide) polymer in the injectable form, it is contraindicated in patients with known allergies to this excipient.
Possible side effect
Common side effects (≥5%) include nausea, headache, dizziness, insomnia, anxiety, and fatigue. Injection site reactions (pain, tenderness, induration, pruritus) are common with the extended-release formulation. Less frequently, patients may experience abdominal cramps, vomiting, decreased energy, joint and muscle pain, or rash. Although rare, serious side effects can include hepatotoxicity (signs include abdominal pain lasting more than a few days, white bowel movements, dark urine, yellowing of skin or eyes), severe depression, suicidality, or eosinophilic pneumonia (with the injectable form). Any unusual or severe symptoms should be reported to a physician immediately.
Drug interaction
Naltrexone has the potential to precipitate acute withdrawal in opioid-dependent individuals; therefore, patients must be completely free of opioids for a minimum of 7–10 days before initiation. It antagonizes the effects of opioid-containing medications, including some cough suppressants and antidiarrheal agents. Caution is advised with concomitant use of hepatotoxic drugs (e.g., certain antifungals, anticonvulsants) due to additive risk of liver injury. Although not extensively studied, interactions with drugs that also undergo extensive hepatic metabolism should be monitored.
Missed dose
If a dose of oral Naltrexone is missed, it should be taken as soon as remembered that day. If it is not remembered until the next day, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. For the monthly injectable formulation, the next dose should be administered as soon as possible, and a new four-week schedule should be established from that date.
Overdose
In the event of a suspected overdose, seek immediate medical attention or contact a Poison Control Center. There is no specific antidote for Naltrexone overdose. Management is supportive and symptomatic. Hemodialysis is not expected to be effective in enhancing elimination due to the drug’s large volume of distribution and extensive protein binding. In cases of massive overdose, accelerated hepatic injury is a theoretical concern, and liver function should be monitored.
Storage
Store Naltrexone tablets at controlled room temperature, 20°–25°C (68°–77°F), in a tightly closed container, and protect from moisture. The injectable suspension must be refrigerated at 2°–8°C (36°–46°F) in its original carton to protect from light. It should not be frozen. The mixed suspension for injection must be administered promptly after preparation. Keep all medications out of the reach of children and pets.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The efficacy and safety of Naltrexone can vary based on individual patient factors and must be determined by a qualified healthcare professional.
Reviews
“Incorporating Naltrexone into my practice has been transformative for many patients struggling with AUD. It provides a tangible tool to reduce the neurological pull of alcohol, which, when combined with therapy, significantly improves outcomes. The extended-release formulation particularly enhances adherence.” — Dr. Eleanor Vance, MD, Addiction Psychiatry
“After years of failed attempts to control my drinking, my physician prescribed Naltrexone. The difference was noticeable within two weeks; the constant mental noise and cravings quieted down enough for me to engage properly in my therapy sessions. It was a crucial part of my recovery toolkit.” — Patient, M., 47
“The evidence base for Naltrexone is robust. It is a first-line pharmacotherapy in our treatment guidelines for a reason. Its mechanism is clear, its side effect profile is generally manageable, and it addresses a core component of addiction—the reward pathway—directly.” — Clinical Pharmacist Specializing in Substance Use Disorders