All types of medications raise some questions when starting or continuing to take them, and naltrexone is no exception. As part of your recovery process, if you are taking naltrexone, you may naturally have a number of questions regarding potential interactions with other drugs. The information in this article will allow you to feel confident that you are using naltrexone safely as part of your recovery.
Naltrexone, available under the brand names Vivitrol, ReVia, and Depade, is a medication used to treat both alcohol use disorder (AUD) and opioid use disorder (OUD), according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Practically speaking, naltrexone—which can be administered orally as a tablet or via intramuscular injection—works by blocking opioid receptors in the body [1].
Why Naltrexone Interactions Happen
How Naltrexone Affects Opioid Medications
Naltrexone works by binding to and blocking the opioid receptors of the body. That means that when you take naltrexone and opioid medications together, the opioid medications will not produce the typical effect of opioids. When you have an opioid dependency, blocking your opioid medications could cause withdrawal symptoms [2].
The Two Main Risks People Should Understand
Precipitated Withdrawal
If an individual has taken opioids and then takes naltrexone, they could experience a sudden withdrawal symptoms. This could occur if a person with a physical dependence on opioids were taking naltrexone, and opioids were still in their body. The sudden emergence of withdrawal symptoms that are precipitated by taking naltrexone can be overwhelming and extremely distressing [1]. This risk of precipitated withdrawal is one of the most serious safety concerns associated with taking naltrexone [2].
Reduced Opioid Tolerance and Overdose Risk
Once an individual stops taking and using opioids and is using naltrexone, that individual’s tolerance to opioids will decrease. Thus, if that same individual relapses and uses the same amount of opioids as they were using before stopping, the likelihood of overdose would increase [4]. This decrease in tolerance and the possibility of overdose were identified by SAMHSA as a critical safety consideration [3].
What Drugs Should Not Be Taken With Naltrexone?
Opioids
NEVER take naltrexone in combination with any opioid (unless your prescriber has developed and documented a specific plan for you).
Examples of opioid medications not to combine with naltrexone:
- Prescription opioid pain medications (e.g., Vicodin, OxyContin)
- Illicit opioid medications (e.g., heroin, fentanyl)
- Opioid cough and cold medications (e.g., codeine)
- Opioid medications to control diarrhea (e.g., Imodium, Lomotil)
Naltrexone blocks the actions of opioid medications [1]. Therefore, if naltrexone is used together with opioids, the patient taking naltrexone will either experience withdrawal symptoms and/or ineffective pain or cough relief [2].
Partial Agonists and Mixed Opioid Agonist-Antagonists
Medications like buprenorphine—available as sublingual tablets, films, or injections—is a partial opioid agonist and acts in a somewhat complex manner on the opioid receptors and may be used in combination with naltrexone following consultation with the prescriber [4]. This combination is used to treat opioid use disorder.
Alcohol Use Disorder Medications and Select Mental Health Medications
Some medications have the potential to increase the incidence of side effects that individuals taking naltrexone may experience, particularly liver-related concerns.
Examples of medications that interact with naltrexone include:
- Disulfiram (oral tablet), which, when taken with naltrexone, may potentially create an increased hazard to the liver [1]. Disulfiram is used for the treatment of alcohol use disorder.
- Thioridazine (oral tablet), a prescription product for schizophrenia, has also been associated with an increased risk of interaction; therefore, this should be evaluated carefully by the prescriber [2]. Thioridazine is very rarely used in the United States.
Bring this list to your appointments with your prescriber:
- All prescription medications
- All over-the-counter medications
- All vitamins, supplements, and herbal products
Common Naltrexone Drug Interactions People Don’t Expect
Cold, Flu, and Cough Products
Always check labels for information regarding opioid content before attempting to use a product. Some cough medications may not now be appropriate to use in conjunction with naltrexone, or the effectiveness of some products may be reduced by naltrexone [3]. If you are unsure, talk to your pharmacist or healthcare provider for assistance with evaluating these products [1].
Sleep Aids and Antihistamines
Several commonly used sleep aids, as well as antihistamines, can cause sedation. If you take naltrexone with sleep aids and/or antihistamines, you may experience increased adverse effects such as drowsiness or dizziness in some cases [2]. Therefore, individualized recommendations from your physician are necessary in this scenario [3].
Supplements and Herbals
A product labeled “natural” does not automatically guarantee interaction-free use. Many types of herbal products and supplements can affect your medications and may also cause or augment adverse effects [1]. Whenever a medication is reviewed, herbals and supplements should also be included [4].
Are There Risks of Interactions?
What an Interaction Can Look Like
The use of naltrexone with another medication raises serious concerns about the possibility of side effects or complications. Individuals who take naltrexone with another medication may present with enhanced or new-onset symptoms related to an interaction [1].
Liver Considerations
Naltrexone is contraindicated in people with active hepatitis or hepatic failure. It should be used cautiously in those with liver disease, with appropriate monitoring of liver enzymes [4].
Planning for Pain Management, Dental Work, or Surgery While on Naltrexone
Why Opioids May Not Work as Expected
Naltrexone blocks opioid receptors; therefore, opioid pain medications may be ineffective [1]. Because of these different effects, patients may run the risk of taking higher doses of opioids, which is clearly unsafe.
