Naltrexone, sold under brand names like ReVia and Vivitrol, is a medication approved to help people manage Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD). The drug works by acting on specific receptors in the brain to reduce cravings and block the reinforcing effects of these substances. Because many people seeking treatment are unsure how this medication interacts with alcohol, there is common confusion about whether it is safe to consume alcohol while on the treatment. This uncertainty often leads to questions about the drug’s purpose and how it is meant to be used.
The Immediate Answer Safety and Treatment Protocols
The direct answer to the question of drinking while taking naltrexone is often yes, depending on the specific treatment protocol designed by a healthcare provider. Unlike medications such as disulfiram, which causes a severe physical reaction when mixed with alcohol, naltrexone does not create a dangerous physical illness or toxic interaction with alcohol. Its function is to change the behavioral response to alcohol consumption, rather than to punish the act of drinking.
There are two main ways this medication is prescribed for AUD, and both are determined by patient goals and medical history. The first is a daily dosing schedule, where the medication is taken once a day to help reduce general cravings for alcohol and maintain abstinence. This approach is typically used after a person has already stopped drinking.
The second, often called The Sinclair Method, involves targeted dosing where the pill is taken approximately one hour before consuming alcohol. This protocol relies on the patient drinking while the drug is active to achieve its therapeutic effect. The goal of this method is not immediate abstinence, but a gradual reduction in the amount of alcohol consumed over time.
How Naltrexone Alters Alcohol’s Effects
Naltrexone works by acting as an opioid receptor antagonist, primarily targeting the mu-opioid receptors in the central nervous system. When a person drinks alcohol, the brain naturally releases endogenous opioids, known as endorphins. These endorphins bind to the opioid receptors, which generates the pleasurable, rewarding, or euphoric feelings associated with drinking.
By occupying these receptor sites, naltrexone effectively blocks the endorphins from binding, thereby dampening the reward pathway. Though the medication does not prevent a person from feeling intoxicated, it significantly reduces the satisfaction and “buzz” that alcohol typically provides. This disruption of the reward signal is the core mechanism of the treatment for AUD.
Over a period of consistent use, this process is designed to lead to a phenomenon known as pharmacological extinction. Extinction occurs when the brain slowly unlearns the association between alcohol consumption and pleasure. Since the positive reinforcement is repeatedly blocked, the neurological drive to seek alcohol diminishes naturally, leading to a reduction in consumption and cravings. This process aims to help individuals lose the motivation to continue drinking.
Important Safety Warnings and Contraindications
While naltrexone is generally well-tolerated, safety warnings must be considered before starting treatment. The most absolute contraindication is the current use of any opioid medications, including pain relievers, or a physical dependence on opioids. Since naltrexone is a powerful opioid blocker, its use in an opioid-dependent person can immediately trigger a severe, acute opioid withdrawal syndrome.
Naltrexone is metabolized in the liver, meaning it carries a warning regarding potential liver toxicity. Patients with active liver failure or acute hepatitis should not take the medication. Healthcare providers typically conduct baseline liver function tests and monitor them periodically throughout treatment to ensure the liver remains healthy.
A range of common side effects may be experienced, particularly during the first few weeks of treatment. Nausea is the most frequently reported side effect, along with other symptoms like headache, dizziness, and insomnia. Taking the medication with food or starting with a lower dose can often help minimize these initial adverse effects.