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Using Naltrexone During Drug Detoxification

Naltrexone is the generic name for a medication used to treat both alcohol use disorder and opioid addiction. As an anti-craving medication, naltrexone may have other applications for other substance abuse problems or compulsive issues, including methamphetamine addiction, smoking cessation, and compulsive gambling; however, the main application is to treat two serious forms of substance abuse in the United States: addictions to opioids and addictions to alcohol.

When Was Naltrexone Approved, and Who Makes It?

The Food and Drug Administration (FDA) originally approved naltrexone for prescription use in the treatment of narcotic addiction in 1984 and the treatment of alcohol use disorder in 1994. Since then, it has proven to be one of the most effective prescription treatments for alcohol use disorder.

There are three brand names for naltrexone: Vivitrol, Depade, and ReVia. Vivitrol is a long-lasting injectable, while ReVia and Depade are prescription tablets. Endo Pharmaceuticals originally developed naltrexone in 1963. Barr Pharmaceuticals manufactures ReVia, Alkermes, Inc. manufactures Vivitrol, and Mallinckrodt, Inc. manufactures Depade.

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Dosing Instructions

A prescription for naltrexone can be administered either orally, as a tablet, or intravenously through injection. The oral tablet is taken once per day, and it can be taken with or without food. The injection is administered once per month at a treatment facility, doctor’s office, or clinic.

The average oral dose for alcohol use disorder is 50 mg per day. However, during detox or inpatient treatment, a person can receive as much as 150 mg per day, depending on their symptoms or need. With injection-form naltrexone, 380 mg is injected into the muscles. When treating narcotic addiction, the dose instead can start at 25 mg, but two or more times per day as needed, with careful monitoring. The person should not take more than 350 mg per week. This can combine to 50 mg every day; 100 mg every other day; or 150 mg every three days.

People who are prescribed naltrexone must have abstained from taking opioid drugs for at least one week (seven days) prior to beginning their prescription. Medical professionals should encourage their patients to keep taking the medication regularly in order for it to be most effective.

How Naltrexone Treats Alcohol and Opioid Addiction

When combined with various therapies and counseling in a rehabilitation program, naltrexone is a very effective treatment for alcohol or drug withdrawal symptoms, especially cravings. When taken as prescribed, this medication can reduce cravings and compulsions, and help to prevent relapse.

Naltrexone is considered an opioid antagonist. This means that it blocks the effects of narcotics on the opioid receptors in the brain. While it apparently blocks opioid receptors, it also has some effect in treating pain at low doses. Medical researchers are currently investigating naltrexone’s potential as a treatment for chronic pain issues, such as fibromyalgia, multiple sclerosis, and Crohn’s disease. A combination of sustained-release naltrexone and sustained-release bupropion (generic Wellbutrin) can be combined off label to help people diagnosed with obesity to lose weight.

Essentially, naltrexone blocks satisfaction or intoxication from substances, so if a person relapses, they are not likely to experience the high associated with the drug of abuse. Instead, they may experience withdrawal symptoms, but the body will stop associating the drug with reward and pleasure.

Naltrexone’s Side Effects

Naltrexone is a potent medication, so it can cause some side effects, which are typically not harmful. These include:

  • insomniaDigestive changes, including nausea, diarrhea, constipation, and vomiting
  • Pain in the stomach
  • Changes to appetite and weight, especially loss of appetite and weight loss
  • Dizziness
  • Headache
  • Anxiety, irritability, and mood swings
  • Changes to physical energy, either increased or decreased
  • Trouble falling and staying asleep
  • Drowsiness
  • Pain in the muscles or joints
  • Rash

Serious side effects should be reported to a doctor immediately. These include:

  • Suicidal ideation or action
  • Intense sadness
  • Anxiety
  • Hopelessness
  • Feelings of guilt for no reason
  • Feeling worthless or helpless
  • Anhedonia, or the inability to feel pleasure or happiness from any activity

These may get worse, so it is important to get medical and psychological help for these mood and behavioral changes as soon as possible.

Other serious side effects can include:

  • Allergic reaction
  • Hallucinations
  • Confusion
  • Blurred vision or other eye problems
  • Wheezing, coughing, or difficulty breathing
  • Severe vomiting or diarrhea, causing dehydration

Naltrexone Interactions

Although it is used in the treatment of opioid and alcohol addiction, naltrexone does not interact with alcohol. It is possible to drink moderately while also taking naltrexone; the medication helps to stifle cravings and prevent compulsive ingestion of intoxicating substances. However, people who still ingest large amounts of opioids or alcohol, due to untreated addiction, should not take naltrexone. Additionally, those who are in rehabilitation for abuse of these substances, or who are recovering from addiction to opioids or alcohol, should not ingest these substances even if they are taking naltrexone.

Naltrexone will also interact with opioid agonists or partial agonists, so it should not be used in combination with buprenorphine or methadone therapy.

People who have problems with their liver or kidneys, or who have a diagnosed mood disorder, should speak with their doctor before beginning a naltrexone prescription.

These conditions include:

  • Depression
  • Hepatitis
  • Liver disease
  • Kidney disease
  • Hemophilia or another bleeding disorder

Some medications that interact with naltrexone include:

  • Cough, cold, or flu medications
  • Antidiarrheal medications, especially those like Imodium that contain a mild opioid
  • Prescription painkillers with opioids
  • Thioridazine (can lead to lethargy and fatigue)
  • Yohimbine (can lead to increased anxiety and high blood pressure)
  • NSAID painkillers (elevate liver enzymes, leading to liver damage)

While naltrexone can interact with these conditions or medications for these conditions, it may not; a doctor can provide the best guidance on an individual basis.

Additionally, women who are breastfeeding, pregnant, or planning to become pregnant should speak with their doctor about naltrexone before beginning a prescription. It is unknown if naltrexone can harm the fetus or infant.

The Necessity of Professional Treatment

According to the National Institute on Alcohol Abuse and Alcoholism, about 7.2 percent of American adults, ages 18 and older, struggled with “problem drinking” in 2012. This includes alcohol use disorders and binge drinking, and it included 11.2 million men and 5.7 million women. The opioid addiction epidemic is increasingly devastating in the US, with 78 people every day dying from opioid overdoses, according to the Centers for Disease Control and Prevention (CDC).

Both opioid addiction and alcohol use disorder are two of the most devastating and deadly epidemics in the US. It is important to get help as soon as possible to overcome these conditions before serious health effects take hold.

Naltrexone during detox and rehabilitation is one part of a larger process in overcoming addiction. A person should work with medical professionals to safely detox from the substance of abuse and enter a complete rehabilitation program to begin therapy. Naltrexone can help to manage cravings, but working with a therapist to develop better coping mechanisms is the best way to manage cravings on a long-term basis. Rehabilitation programs use medical research and evidence-based techniques to help people overcome addiction and maintain their sobriety.