Naltrexone
A medication blocking alcohol's pleasurable effects, reducing cravings and rewarding sensations from drinking. Available as daily pills or monthly injections, naltrexone helps maintain sobriety by making alcohol less appealing if relapse occurs.
TL;DR
Naltrexone is a non-addictive medication that reduces the pleasure and cravings alcohol produces, making relapse less rewarding and easier to stop.
Key Points
- âś“Blocks alcohol's feel-good effects so drinking becomes less appealing
- ✓Available as daily pill or monthly shot—choose what fits your life
- âś“Works best after 4+ days sober and paired with counseling
- âś“Does not make you sick if you drink, but stops the high
Naltrexone is like turning down the volume on alcohol’s siren song. Instead of making you violently ill if you drink, it quietly removes the euphoric payoff that keeps the cycle going. Most people describe the experience as: “I can still have a drink, but it just doesn’t do anything for me—so why bother?”
How to start and stay on it
You need to be opioid-free (no pain pills or heroin) for 7–10 days first; otherwise it can trigger sudden withdrawal. After that, you have two options:
- Daily pill (ReVia, generic): 50 mg once a day, usually in the morning. Set a phone alarm, keep the bottle visible, and track doses in a recovery app.
- Monthly shot (Vivitrol): 380 mg injected into your buttock by a nurse or doctor. Good if you worry about forgetting pills or want to avoid the daily decision.
Most clinicians recommend at least 3–4 months of treatment; many continue for 6 months or longer if cravings linger. Pair the medication with therapy, SMART Recovery, or AA—people who do both see 15% better outcomes than medication alone.
What to expect and watch for
Within the first week, you may notice cravings fade and, if you slip, drinks feel flat. Common early side-effects—mild nausea, headache, or fatigue—usually disappear after a few days. Drink plenty of water and take the pill with food to reduce stomach upset.
Safety tips:
- Carry a medical alert card or phone note: "On naltrexone—opioid painkillers won’t work." Emergency teams need to know.
- Avoid combining with opioids, kratom, or large doses of sedatives; the blocking effect can make these substances ineffective or dangerous.
- If you plan elective surgery, tell your surgeon well in advance.
If heavy drinking continues after 4–6 weeks, ask your prescriber about raising the oral dose to 100 mg or switching to the injectable form.
Who benefits most
Research shows stronger effects in men and in people who achieve at least 4 days of abstinence before starting. Genetic testing for the OPRM1 gene can sometimes predict better response, but trial-and-error is still common. Women often respond too, though sometimes less dramatically.
Naltrexone is not a moral crutch—it’s a medical tool that quiets the brain’s reward loop long enough for counseling, new habits, and support networks to take hold.