Naltrexone

Published July 6, 2024 , Updated July 17, 2024

Tags:

Table of Contents

Naltrexone
Naltrexone (Vivitrol, Revia)

Naltrexone (Vivitrol, Revia)

Naltrexone is a psychiatric medication used to mitigate cravings and decrease the chance of relapse in patients suffering from opioid and/or alcohol use disorders¹. It is a medication assisted treatment option that may be used with talk or other therapies to combat the disorder.

It’s available as a generic drug under the name Naltrexone or as a once monthly extended release injection, patented under the brand name Vivitrol. Any person licensed to prescribe medications may administer naltrexone.

It’s FDA approved for opioid and alcohol use disorders, but may be effective in helping with other similar issues. It has been prescribed in the off-label treatment of other substance use disorders², compulsive disorders³, and obesity.

Naltrexone is not an opioid and is non-addictive. Do not confuse Naltrexone, the anti craving medication, with Naloxone (Narcan), the emergency medication used to treat opioid overdoses.

Mechanism of Action

Opioid receptors are what opioids bind to in the brain, triggering their euphoric and pain-relieving effects. Naltrexone is an opioid receptor antagonist, meaning it blocks opioid receptors. There are three known types of opioid receptors in the brain. Naltrexone primarily blocks the μ (mu) opioid receptors, but may block all of them to a lesser extent⁴.

By blocking this receptor, the rewarding effects of using opioids and alcohol are heavily reduced. Over time, cravings for alcohol and opioids may be reduced.

Accessing Treatment

Naltrexone is relatively inexpensive. Even without insurance, it’s $15-$25 for a monthly supply. You can discuss Naltrexone with a doctor specializing in addiction, psychiatrist, nurse practitioner, or your general physician.

If you don’t have a doctor or insurance, online programs allow you to consult with a doctor via video chat. You can have the prescription mailed to you through an online pharmacy, including Amazon pharmacy. If you’re looking to start on Naltrexone with a limited budget from the convenience of your home, please check out WebDoctors or JoinMonument.com (both for USA). Programs range from $50-$150 up front, then a small monthly fee.

Administration

Naltrexone is administered orally as a pill taken once daily, or administered by a licensed professional as a once monthly injection. The typical dose in pill form is 50mg per day⁵, but may be higher or lower depending on the doctor’s recommendations.

The generic pill form is the less expensive option. It can be prescribed by any licensed medical professional and is easy to get at nearly any pharmacy.

Vivitrol Injection

Vivitrol, created by the Ireland-based biotech company Alkermes, is an extended release version of naltrexone. It’s an intramuscular injection given at the top of the buttock⁶. The injection contains microscopic capsules of naltrexone, which slowly dissolve at different intervals throughout the month. Its patent is still active, so no generic forms are available. It must be administered by a medical professional (usually a nurse or physician) in a clinical setting. It must be refrigerated for storage and transportation. These factors all make it much more expensive than the generic pill form.

The advantage of Vivitrol is that the patient is medicated for an entire month, without the need to take a pill every day. This makes compliance more likely, as the patient cannot simply stop taking it one day in order to get high the next, or forget a dose. Medical insurance can cover most of the cost (over $1000/injection), but it may still be prohibitively expensive for some patients with copays, deductibles, or lack of insurance.

It’s rare, but some people may be allergic to naltrexone. For this reason, it is best practice to try taking the pill orally before committing to a Vivitrol injection.

Prerequisites

Before starting Naltrexone, the patient must be clean of all opioids for at least one to two weeks. If opioids are still in the patient’s system at the time of administration, Naltrexone will send them into near immediate opioid withdrawal. Patients may be asked to take drug tests prior to receiving naltrexone, to ensure no opiates remain in their system.

Interactions

If a person drinks alcohol while also using naltrexone, the euphoric effects of the alcohol may be reduced. They will still become intoxicated. It’s not like Antabuse (disulfiram), the medication that makes people feel violently ill after drinking.

If a person uses opioids while also on naltrexone, they will not feel the euphoria they are used to. In order to get high, the patient will have to either take enough opioids to “override” the naltrexone, which is extremely dangerous, or wait a few days for the naltrexone to leave their system. Do not use opioids while using naltrexone. If you plan on relapsing, wait until it leaves your system (or better yet, seek help).

While being treated with naltrexone, it’s important that the patient understand the interaction between naltrexone and opioids, even if the patient did not previously abuse opioids. For example, if the patient gets into a severe accident and needs emergency medical treatment, the doctors treating them must know the patient has naltrexone in their system, so they may factor it into decisions regarding pain management. Patients are encouraged to keep a medical information card in their wallet stating that they are taking naltrexone. Then, first responders can review it in the event of a medical emergency.

Side Effects

A significant amount of side effects may occur while taking naltrexone. Usually, the side effects are strongest in the beginning and go away after a week or two, once the patient adjusts to the medication.

Common Side Effects⁷Mayo Clinic. Naltrexone Side Effects.
- Nausea, dizziness
- Headaches
- Tiredness or Trouble Sleeping
- Muscle aches
- Runny nose

If you’re starting Naltrexone, you will probably experience some of these unpleasant side effects during the first week or two. I’d encourage you to get past the first few weeks and see if they go away. If they do not, consult with your doctor and discuss stopping the medication. Sometimes, starting at a lower dose and gradually increasing it reduces the severity of side effects.

Long Term Effects

Naltrexone may negatively impact the liver. Getting regular checkups by a doctor and lab work is important while taking naltrexone.

The Sinclair Method

The Sinclair Method (TSM) is an alternative treatment option for alcohol use disorder using naltrexone. It’s attributed to Dr. John David Sinclair, an American psychologist who extensively researched addiction throughout his life. This method of treatment is now getting wider acceptance.

Naltrexone has been proven effective at reducing cravings. For individuals continuing to drink on Naltrexone, it has been proven to reduce the amount consumed. It reduces the brain reward and euphoria which occurs when drinking. TSM is based on these principles.

TSM allows people to continue drinking, with the goal of reducing consumption to normal levels or eventually quitting altogether. It may seem counterintuitive to tell an alcoholic to continue drinking, but if you understand how naltrexone works, it makes sense.

When practicing TSM, patients are told to take naltrexone one hour before they plan on drinking, every time they plan on drinking. Since the reward factor behind drinking is mitigated with naltrexone, the drinker is less incentivized to continue drinking. They still become intoxicated, they just won’t feel as rewarded after drinking as they had been previously. Over time, these behaviors become reinforced. The individual practicing TSM will no longer feel the same rush or “high” from drinking that they used to. The person may eventually find themself drinking at safer levels, or decide to quit entirely.

TSM has proven effective for many people. Arguably, the most difficult part of this method is maintaining compliance. Taking a pill and waiting an hour is difficult for many people in active addiction. Some people may not like the experience of drinking on naltrexone, as it can be less euphoric. It could also be seen as an excuse to continue drinking, while lying about taking the naltrexone, and not fully committing to the treatment. It must be taken on time, every time.

Additionally, this treatment option is not immediately effective. It can take several months, possibly years for drinking levels to significantly decline. All that time, they must maintain near 100% compliance with the medication regimen. A single slip up on the medication can lead right back to unhealthy levels of consumption.

Finally, many people who drink to excess use alcohol as a crutch or an escape from reality. They may find that while practicing TSM, this escape is no longer there. They’re not getting the euphoria they’re used to, they haven’t dealt with their other core issues, and they’d rather give up on TSM to continue mentally escaping their problems.

If you think The Sinclair Method may be helpful for you or a loved one, check out the following websites:

Notice

I am not a doctor or other medical professional. I am not qualified to provide medical advice. This article merely contains information sourced from other reputable sites, along with knowledge from my own experiences. Always consult with a medical provider when making decisions regarding your health and treatment options.