How Does Naltrexone Work for Alcohol?

Naltrexone Alcohol

Naltrexone is an approved medication in the United States that can help with substance abuse and dependence. Initially, for opioid use disorders (OUD), there is also a benefit of naltrexone for alcohol dependence. The naltrexone alcohol relationship is similar to how the medication works for an OUD, and we’ll detail more below.

What is Medication-Assisted Treatment (MAT)?

First, naltrexone is part of a larger field of medicine called medication-assisted treatment, or MAT, according to the Mental Health Services Administration and Health and Human Services. 

  • When someone struggles with a substance use disorder, medication-assisted treatment can help them overcome cravings and withdrawal symptoms, improving their likelihood of remaining in a treatment program.
  • MAT is not supposed to be used on its own. Addiction is a highly complex chronic disorder affecting behavior, emotions, and mental and physical health. MAT can be one part of treating the disorder.
  • Behavioral therapy should be used along with medicines and medical management to take a whole-patient, comprehensive and individualized approach to treating addiction.
  • Along with helping someone initially stop using substances as an initial treatment,  MAT can promote long-term, sustained recovery.
  • The most common use of MAT is in people with opioid use disorders, but people with alcohol use disorders can also benefit.
  • Over the past several years, the prescribing ability of health care providers to give MAT has increased significantly. 
  • For opioid use disorders, in particular, MAT is considered the gold standard treatment approach.
  • When someone takes medications, they can reduce uncomfortable withdrawal symptoms and help the brain to stabilize. 
  • Medication-assisted treatments can be used across different environments, including residential rehab and outpatient programs.

What is Naltrexone?

Naltrexone is a generic prescription drug the FDA approves for the MAT of opioid use disorders and alcohol use disorders. Naltrexone brand names include Revia and Vivitrol.

  • Naltrexone is classified among opiate antagonists, so it doesn’t work the same as opioid medication. When someone takes an opioid antagonist medication, the mechanism of action blocks the opioid receptors in their brains, reducing the levels of craving. Naltrexone can also reduce the euphoric or sedative opioid effects.
  • Opioid analgesics are prescription pain medications that are highly addictive, especially when used at higher than normal doses. Opioid street drugs include heroin
  • Whether by prescription or when talking about heroin, these drugs work the same way. They bind to the mu-opioid receptor. In doing so, it reduces the perception of pain. These drugs also create feelings of euphoria and relaxation. They can trigger a reward response, which is why they’re addictive. 
  • The risk of overdose is high. Opioids slow down the central nervous system. If a dose that’s too large is taken, the CNS can slow down so much that a person experiences problems with breathing and heart rate. 
  • Methadone is an opioid agonist, so it has many of the same risks as the drugs themselves, including overdose and abuse potential. 
  • Buprenorphine is also an MAT, and it’s a partial opioid agonist, meaning it partially activates the same receptor sites as the drugs. 

Taking a naltrexone dose for opioid dependence can prevent the drugs from having any effects because of these mechanisms of action. 

  • One of the benefits of naltrexone over some other MATs is that it is not habit-forming, so there’s no potential for abuse or addiction.
  • The medicine was initially approved to treat alcohol dependence in 2006 and sold under the brand name Vivitrol. 
  • In 2010, the medicine got FDA approval as a monthly injection for dependence on opioid drugs. 
  • This medication works differently than other opioid use disorder treatments. For example, methadone and buprenorphine activate the opioid receptors in the body to prevent cravings like other endogenous opioids.
  • Naltrexone binds to and then blocks opioid receptors, so it’s not considered a drug with abuse potential.
  • If a person takes the medication and then relapses with doses of opioids, it will prevent them from feeling high. There aren’t going to be any of the pleasurable effects of opioids. 
  • There is still a risk of an opioid overdose when someone uses extended-release naltrexone or oral tablets for opioid addiction. 

For most people, the side effects of oral and injectable-extended release naltrexone are minimal and may include upset stomach, headache, or diarrhea. 

  • Other common side effects of naltrexone can include abdominal pain and stomach pain, joint pain, muscle pains, muscle aches, and muscle cramps. 
  • Runny nose and symptoms similar to a cold can also occur in some people. 
  • Again, adverse events are pretty rare and usually mild, with doses of naltrexone as a treatment for alcohol dependence and opioid dependence.  
  • If someone experiences severe side effects like shortness of breath, they should need medical treatment. 
  • Some people worry about liver failure, liver damage, or liver disease when using this medicine. If you use it as prescribed and instructed by a health care professional to manage alcohol dependence at therapeutic doses, this is very unlikely. If it’s a concern, your health care provider will monitor you with liver function tests. 

To take this medication, you should have already gone through acute opioid withdrawal and not have used opiate drugs within the past 7 to 10 days to avoid adverse effects, according to the National Institute on Drug Abuse. 

An Overview of Alcohol Use Disorders

An alcohol use disorder or AUD is a medical condition. An inability to stop drinking or control your use of alcohol even though there are negative consequences characterizes alcohol use disorders. AUD can broadly include alcohol abuse, addiction, and dependence.

This brain disorder can be mild, moderate, or severe. The long-term changes in the brain stemming from the effects of alcohol can make the risk of relapse high for some people.

Symptoms of an alcohol use disorder can include:

  • Frequently drinking more or for longer than you intend.
  • Wanting to cut down on alcohol or stop drinking but not being able to.
  • Spending a lot of time drinking or recovering from the effects, like hangovers.
  • Being focused on how badly you want to drink when you aren’t and experiencing alcohol cravings. 
  • You experience problems in functionality in your daily life due to drinking.
  • Continuing to drink even when it impacts your family and relationships negatively.
  • You cut back on or stop doing activities that were once important to you, to drink instead.
  • Finding yourself in dangerous situations due to the use of alcohol, like drinking and driving.
  • Developing a tolerance and needing to drink more to get the desired effects.
  • Withdrawal symptoms occur when you aren’t drinking, like shakiness, nausea, or sweating. Withdrawal can indicate physical dependence. 

While treatment of alcohol dependence is very individualized and plans are based on your individual needs, there are usually three categories for alcohol use disorder. Medications like treatment with naltrexone are one category of a possible treatment for AUD.

The next is behavioral treatments, and the third is mutual support groups like a 12-step program. For most people, all three are best.

The Relationship Between Naltrexone and Alcohol

So how does naltrexone work for alcohol?

Many medications for alcohol use disorder make people feel sick after they drink. Naltrexone in alcohol dependence is different. 

  • Researchers believe it works by changing how the brain responds to drinking. 
  • There appears to be a release in endorphins when you have something intoxicating, like alcohol.
  • Naltrexone blocks the endorphins from binding to receptors so that you won’t feel drunk or experience euphoria from drinking.

You can still have the outward signs of alcohol use, but the pleasure of drinking and the rewarding effects go down significantly through the blockade by naltrexone. 

Naltrexone Alcohol

What is Vivitrol?

One of the naltrexone brand names is Vivitrol, and it may be what you hear about most often. Vivitrol is a long-acting injectable naltrexone treatment for alcohol use disorder. 

  • All forms, including the long-acting naltrexone drug Vivitrol, block the euphoria of central nervous system depressants.
  • You take Vivitrol by injection once a month, which helps avoid the issue of noncompliance stemming from taking a daily oral medication. You do have to see a health care provider. 
  • The extended-release injectable naltrexone is gradually released into your system when you receive Vivitrol. 
  • The recommended dose is usually 380 mg, taken every four weeks in an alcohol-dependent person. 
  • Around 14 days after receiving a dose, the concentration of the medication begins to decline gradually, but you’ll continue to have measurable levels in your system.

You can also take oral naltrexone. The oral form of naltrexone doesn’t have to be given by healthcare providers, but you have to remember to take it daily or as instructed. 

Can You Drink When You’re on Naltrexone?

If you combine the two, there don’t seem to be any major naltrexone alcohol interactions. The medicine should help you experience a reduced urge to drink and reduce alcohol consumption, if not altogether abstinence.

However, if you were to drink alcohol with a dose of naltrexone, you won’t become very sick like you would with Antabuse.

Alcohol Addiction Treatment in the San Francisco Bay Area

Medication-assisted treatment isn’t for everyone, but it can be highly effective for some when it’s part of a larger treatment plan. The effectiveness of naltrexone for the treatment of alcohol use disorders is good for many people. When the cravings for alcohol go down in response to naltrexone, people can focus more on their treatment and recovery. 

Insurance will often cover some or all of the costs of medication-assisted treatment and rehab and behavioral therapy.

Interestingly, there is growing research and current ongoing study on this medicine, not only for patients with alcohol use disorder or opioid disorders. Low-dose naltrexone is being looked at to help with chronic pain and autoimmune disorders and may even have therapeutic effects for some people with cancer. 

However, the doses used for immune modulation and other therapeutic effects are much lower than when used for the treatment of alcohol dependence or opioid use disorder. 

If you’d like to explore treatment programs in the San Francisco bay area, call Silicon Valley Recovery at 408-547-4089. We offer options to detox, reduce cravings, and treat the underlying causes of your addiction. 

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