Yes, you can smoke while taking naltrexone. There is no dangerous interaction between cigarettes and the medication. Naltrexone is FDA-approved for treating alcohol and opioid dependence, not nicotine dependence, and many people who take it are active smokers. What you’ll likely notice, though, is that smoking feels different while you’re on it.
Why Smoking Feels Different on Naltrexone
Naltrexone works by blocking opioid receptors in the brain, and those receptors play a bigger role in smoking than most people realize. When you inhale nicotine, it triggers a release of feel-good chemicals in your brain’s reward system. Opioid receptors help amplify that pleasurable signal. Naltrexone essentially turns down the volume on that process.
In a randomized controlled trial of over 300 smokers, those taking naltrexone reported lower pleasure from cigarettes, less appealing taste, and reduced urge to smoke compared to those on a placebo. The effect on cravings and taste held up even after researchers accounted for other factors like nausea (a common naltrexone side effect that could independently make smoking less appealing). People on naltrexone also smoked fewer cigarettes per day, cutting back by about four cigarettes compared to roughly three in the placebo group.
So while smoking on naltrexone isn’t harmful, you may find cigarettes less satisfying. Some people describe it as smoking out of habit rather than genuine enjoyment.
Will Naltrexone Help You Quit Smoking?
Despite making cigarettes less rewarding, naltrexone hasn’t proven effective as a standalone quit-smoking tool. In a clinical trial tracking smokers for six months, quit rates were nearly identical between naltrexone and placebo. At the 26-week mark, 12% of people in both groups had stopped smoking. Continuous abstinence rates were even lower: 5.3% for naltrexone versus 8% for placebo.
The disconnect makes sense when you think about it. Nicotine addiction involves multiple brain systems, not just the opioid pathway that naltrexone targets. Reducing the pleasure of a cigarette doesn’t necessarily override the habit loops, the stress relief, or the physical withdrawal symptoms that keep people smoking. Naltrexone chips away at one piece of the puzzle, but it’s not enough on its own to help most people quit.
There is some evidence that combining naltrexone with a nicotine patch may work better than either alone, since the two have complementary effects. The patch manages nicotine withdrawal while naltrexone dampens the reward from any cigarettes you do smoke. But this combination hasn’t been studied extensively enough to become a standard recommendation.
The Drinking and Smoking Connection
If you’re taking naltrexone for alcohol dependence and you also smoke, there’s an interesting wrinkle. Naltrexone appears to reduce cigarette cravings specifically when you’re drinking or in situations where you’d normally drink and smoke together.
In a lab study of heavy-drinking smokers, naltrexone blunted the urge to smoke as blood alcohol levels rose. The effect was strongest at higher levels of intoxication, which is exactly when many smokers reach for a cigarette most automatically. This makes practical sense: alcohol amplifies the reward system that naltrexone is blocking, so the medication’s dampening effect becomes more noticeable during drinking.
For people being treated primarily for alcohol dependence, though, naltrexone doesn’t appear to reduce overall daily cigarette counts. In a 16-week trial of alcohol-dependent smokers, there was no meaningful difference in cigarettes smoked per day between the naltrexone and placebo groups. The participants weren’t trying to quit smoking, which likely matters, but the finding suggests naltrexone won’t quietly wean you off cigarettes just because you’re taking it for drinking.
What to Expect if You Keep Smoking
Smoking while on naltrexone won’t interfere with the medication’s effectiveness for alcohol or opioid treatment. In fact, some research suggests naltrexone may work slightly better for reducing heavy drinking in people who also smoke, though the reasons aren’t fully understood.
The most common side effect of naltrexone is nausea, which can be more noticeable in the first week or two. Smoking on top of nausea can make your stomach feel worse, so if you’re just starting the medication, you may want to pay attention to timing. Some people find that eating before taking naltrexone and waiting a bit before their first cigarette helps.
The bottom line is straightforward: naltrexone and cigarettes don’t create any dangerous medical interaction. You may enjoy smoking less, you may smoke a few fewer cigarettes per day, and you may notice reduced cravings in certain situations, particularly when drinking. But the medication alone is unlikely to be your path to quitting tobacco. If quitting smoking is a goal, it’s worth exploring options specifically designed for that purpose, like nicotine replacement or medications that target nicotine dependence directly.