- Addiction & recovery
Can You Drink on Naltrexone?
David Schwartz, MD
September 6, 2021
Addiction claims the lives of thousands of Americans each year and affects millions more. Addiction, also known as substance use disorder (SUD), is a medical condition in which people find it difficult to stop or manage their substance use despite social, occupational, or health repercussions. According to the National Institute of Mental Health (NIMH), substance use disorder is classified as a chronic, relapsing mental disorder that can vary in severity. It causes long-term alterations in the brain, perpetuating the condition and making people vulnerable to a relapse. Fortunately, many evidence-based treatments and medications are available to help individuals with a SUD achieve and maintain sobriety, regardless of its severity.
Treatment for substance use disorders often involves abstinence-only based approaches. However, some individuals can benefit from treatment even while still using it. One such alternative treatment involves a medication called naltrexone, which allows individuals to reduce their heavy drinking habits gradually.
Naltrexone is usually recommended for individuals who have stopped drinking or completed an alcohol detoxification program. However, individuals actively consuming alcohol can also participate in naltrexone treatment.
How Does Naltrexone Work
Naltrexone is a medication approved by the U.S. Food and Drug Administration (FDA) to treat both opioid use disorder (OUD) and alcohol use disorder (AUD). Naltrexone is marketed under the brand names of ReVia, Vivitrol, and Depade. And is designed to help manage opioid and alcohol cravings and feelings of intoxication associated with substance misuse.
Naltrexone is an opioid antagonist, meaning that it works by blocking the intoxicating and sedative effects of opioids like heroin, morphine, and codeine. Its mechanism differs from that of buprenorphine and methadone, which stimulate opioid receptors and reduce cravings. Naltrexone, as a medication for alcohol use disorder (MAUD), works by blocking the endorphin receptors in the body to suppress the effects of alcohol. Naltrexone, unlike many other medications, possesses no risk of misuse or dependence. In addition, naltrexone is a non-addictive and non-narcotic medication that does not cause withdrawal symptoms during cessation.
As with any maintenance medications, it’s most effective when combined with a comprehensive treatment plan that includes counseling, behavioral therapies, and social support groups.
How Is Naltrexone Prescribed?
Although naltrexone isn’t a controlled substance, it’s currently available only via a prescription. Any licensed physician can prescribe naltrexone to adults 18 years of age and older. The extended-release injectable naltrexone (Vivitrol), on the other hand, does have to be administered in a clinical setting.
Naltrexone in pill form (ReVia, Depade) is taken once a day at a dose of 50 mg. In contrast, the injectable extended-release form (Vivitrol) is given once a month at a dose of 380 mg intramuscularly. Missing doses can hinder its effectiveness and increase the risk of a relapse.
Individuals are advised to abstain from illegal opioids and opioid medication for at least seven to 14 days before starting naltrexone to lower the risk of precipitated withdrawal, also known as sudden opioid withdrawal syndrome (SOWS). While naltrexone cannot be taken with opioids in the system, it can be taken while still drinking. The duration of naltrexone treatment varies from person to person, depending on individual needs and circumstances.
Drinking While on Naltrexone
Naltrexone can be a beneficial tool for those who wish to cut down on drinking. When taken as prescribed, naltrexone allows people to drink alcohol in moderation and reduce their motivation to keep drinking.
Naltrexone functions by:
- Reducing craving for alcohol
- Suppress the effects of alcohol
- Reduce the risk of relapse
- Improve overall treatment retention
The main goal of most rehabilitation programs is complete alcohol abstinence. However, for some individuals with severe alcohol use disorder disease, avoiding or preventing relapses may be very difficult. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 50% of individuals relapse within 12 weeks after starting treatment. And up to 90% will relapse at least once in the four years after treatment. When continuous abstinence is not possible, or for those who are not setting a goal of abstinence but rather wish to have controlled drinking, other goals, such as lowering the number, frequency, or severity of relapses, may be of significant value.
According to research, those who take naltrexone experience fewer heavy drinking days and cravings, which means they can better regulate their drinking habits. They can also maintain a level of drinking that is comfortable for them, whether that means cutting back, moderating or controlling their alcohol consumption, or quitting entirely.
It’s vital to note that drinking heavily while on naltrexone to “get over” the boundary and enjoy the effects of alcohol is never a good idea. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), although it’s safe to drink in moderation and for a reasonable amount of time while on naltrexone, continuing to misuse alcohol can create toxic effects that could damage the liver.
How Long Does Naltrexone Last?
How long naltrexone stays in the body depends on many factors. These factors include the type of medication taken (oral pill or a monthly injection) and the screening method.
The timetable for detecting naltrexone in the system is also dependent upon factors such as:
- Metabolism – Individuals with faster metabolisms will eliminate medications more quickly.
- Weight – Having a higher percentage of fat can affect medication distribution and metabolism.
- Age – Younger individuals typically process medications faster.
- Health – Health issues, such as chronic illnesses, can affect how long medications stay in the body.
- Hydration – Dehydration may significantly slow down the time it takes to clear the body of the medication.
Naltrexone can be found in urine for up to six hours after the last dose. Most variants of oral naltrexone can be detected in a blood test for up to 24 hours. In addition, naltrexone can be detected for up to a day in a saliva test and up to 90 days in a hair follicle test. Naltrexone medications such as Vivitrol can remain detectable in drug tests for more than 25 days.
How Long Does Naltrexone Block Alcohol?
According to the U.S. Food and Drug Administration (FDA), naltrexone has a maximum effect of one hour after administration. The anti-craving effects of naltrexone last longer than many other medications. And naltrexone has a half-life of four to 13 hours in the body. The half-life of a medication refers to the time it takes for the active substance of the medication to reduce in half. Naltrexone is normally taken before drinking and usually lasts the entire night, which is why only one tablet is advised per day.
What to Avoid When Taking Naltrexone
Like most medications, naltrexone can interact with other substances and cause severe side effects. Because naltrexone is used to treat alcohol and opioid addiction, individuals are advised to avoid these substances during treatment.
The following medications can adversely interact with naltrexone:
- Diarrhea medications
- Cough medications
In addition, avoid using illicit substances while taking naltrexone as they can increase the side effects of the medication. Discuss all medications currently being taken, including over-the-counter medications and herbal supplements, with your doctor before naltrexone treatment. It’s also important to inform your physician if you’ve recently used opioids or opioid-containing medications for any medical condition before starting naltrexone to avoid an opioid withdrawal.
Individuals who wish to be on naltrexone treatment may initially undergo a naloxone challenge test before treatment. This test is performed to evaluate physical dependence on opioids. You will be given naltrexone orally, as an intramuscular injection, or by IV. A positive test is suggestive of physical dependence and consists of common withdrawal symptoms. If your naloxone challenge test is positive, or if you test positive for opioids, naltrexone treatment will be delayed in order to avoid causing opioid withdrawal symptoms.
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