Your doctor prescribed naltrexone to support your recovery from opioid use disorder (OUD). Still, you might wonder: Can you drink while taking this medication, or should alcohol be off the table completely? Alcohol may not directly interact with naltrexone in a dangerous way, but drinking can still be unsafe in some situations.

Naltrexone is one of three medications approved by the U.S. Food and Drug Administration (FDA) to treat OUD, along with buprenorphine and methadone, as part of a treatment approach called medications for OUD (MOUD). Naltrexone works by blocking opioid receptors (areas on brain cells where opioids attach). This prevents opioids from producing their usual intoxicating effects while naltrexone is active.

Naltrexone is also approved to treat alcohol use disorder (AUD). If you’re living with OUD and also have AUD, your doctor may have prescribed naltrexone to treat both conditions.

Here’s what to know about drinking alcohol while taking naltrexone for OUD, including possible side effects, factors that may affect your safety, and when to check in with your healthcare provider.

How Does Naltrexone Work?

Naltrexone’s role in OUD treatment comes down to how it interacts with opioid receptors in the brain and what that means for starting treatment safely.

Blocking the Effects of Opioids

Naltrexone belongs to a group of medications called opioid antagonists. These drugs attach to opioid receptors in your brain without activating them. This blocks other opioids — like heroin, fentanyl, or prescription pain relievers — from producing their usual effects.

If you use opioids while naltrexone is active in your system, you likely won’t feel the usual high. By blocking these effects, naltrexone can help reduce the risk of returning to opioid use. The medication blocks the effects of opioids and may also reduce opioid cravings, helping prevent a return to opioid use.

Naltrexone comes in two forms:

• A tablet taken by mouth
• A once-monthly injection called extended-release naltrexone (Vivitrol)

Both oral naltrexone and extended-release injectable naltrexone have been used in the treatment of opioid dependence. However, only the injectable form is specifically indicated to prevent relapse (return to opioid use) after opioid detoxification.

Only the injectable form is FDA-approved specifically to treat opioid use disorder.

The pill also blocks opioid receptors, and it’s FDA-approved for AUD. If you have both OUD and AUD, your care team may recommend naltrexone to address both conditions, since it works on the reward pathways involved in each.

Starting Naltrexone Safely

Before starting naltrexone, you’ll need to be opioid-free for a period of time — at least seven days after short-acting opioids or 10 to 14 days after long-acting opioids — to avoid triggering sudden withdrawal.

Doctors also typically pair naltrexone with counseling or other behavioral therapies, since this combined approach can help address both physical cravings and the habits or triggers tied to substance use.

Can You Drink Alcohol While Taking Naltrexone?

Yes, you can physically drink alcohol while taking naltrexone. Unlike disulfiram, naltrexone doesn’t cause a severe physical reaction — like vomiting or flushing — when mixed with alcohol.

That said, the bigger concern for people in OUD treatment isn’t a reaction between naltrexone and alcohol — it’s that you can still become impaired, lose coordination, or experience poor judgment. Naltrexone reduces the reward you feel from drinking, but it doesn’t block alcohol’s effect on the rest of your body.

What Factors Affect the Safety of Drinking Alcohol on Naltrexone?

Several factors can influence how safe it is to drink while taking naltrexone for OUD. Understanding these can help you make informed choices and know when to loop in your doctor.

Your Recovery Goals and Drinking Patterns

If you’re working toward abstinence from opioids, alcohol can still play a major role in relapse. Because alcohol lowers inhibitions, even light or occasional drinking can make it easier to slip back into old patterns and may increase the risk of a relapse. It’s worth talking with your provider about how alcohol fits into your overall recovery plan.

If you also have a history of heavy drinking or AUD, naltrexone can help manage your alcohol cravings alongside your OUD treatment. For this co-occurring condition, your provider can help you decide which makes the most sense for your personal safety: avoiding alcohol completely or simply cutting back to a more manageable drinking pattern.

Opioid Tolerance and Overdose Risk

While you’re on naltrexone and staying opioid-free, your opioid tolerance can drop significantly.

If you relapse and use the same amount of opioids you used before treatment, it can be life-threatening, since your body may no longer be able to handle that dose. Alcohol can make a lapse more likely by impairing judgment, though the tolerance risk exists either way.

If you or someone near you shows signs of an opioid overdose — slowed or stopped breathing, unresponsiveness, or discolored lips or nail beds — give naloxone and get emergency help right away.

Keep naloxone on hand, and consider carrying a card noting your naltrexone treatment.

Liver Health

Your liver processes both alcohol and naltrexone. If you have liver problems, drinking alcohol may add extra strain and increase your risk of liver damage.

Your doctor may check your liver function with blood tests before and during treatment. This helps catch any issues early, especially if you drink regularly or have a history of liver disease, acute hepatitis, or liver failure.

Other Medications and Health Conditions

Naltrexone can interact with other medications, including certain pain relievers. If you’re prescribed opioid-containing medicine for pain, cough, or diarrhea, or if you’ve used opioids recently, tell your doctor. Starting naltrexone too soon after opioid use can trigger sudden withdrawal symptoms.

Share your full medication list and any health conditions, like kidney disease or a history of depression, so your provider can tailor your treatment plan and know how often you drink.

If you’re pregnant, planning to become pregnant, or breastfeeding, tell your doctor before starting naltrexone so they can weigh the risks and benefits with you.

When Does Drinking Alcohol Increase Risks Despite Naltrexone?

Naltrexone can lower cravings, but it doesn’t eliminate every risk tied to drinking. Heavy or binge drinking can still lead to accidents, poor decisions, and other health complications.

For people in OUD treatment, the bigger concern is often what alcohol does to judgment and self-control. Impairment can make it harder to stick with coping strategies or follow through on appointments, and it can raise the chances of a relapse back into opioid use at a point when your tolerance is lower than it used to be.

Ongoing or heavy drinking can also affect your liver, heart, and mental health over time. Naltrexone works best alongside counseling and support from people around you.

If you notice you’re drinking more than planned, or if cravings or other symptoms continue despite treatment, it’s worth talking to your provider about adjusting your plan.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

How has naltrexone changed the way you experience alcohol? Let others know in the comments below.