Naltrexone is a prescription medication, so you’ll need a doctor’s order to get it. The good news is that any licensed prescriber can write that prescription, unlike some addiction medications that require special certifications. The process is straightforward: see a provider, get evaluated, and fill your prescription at a pharmacy. The specifics depend on what you’re taking it for and which form you need.
What Naltrexone Is Prescribed For
Naltrexone has three FDA-approved uses: alcohol use disorder, opioid use disorder, and (in combination with bupropion) obesity. It works by blocking opioid receptors in the brain, which reduces cravings for alcohol and opioids and eliminates the euphoric effects of opioid drugs. A growing number of people also seek it in low doses for off-label purposes like chronic pain conditions, but the standard prescribing pathway centers on those three approved uses.
Who Can Prescribe It
Any practitioner with a license to prescribe medications can write a naltrexone prescription. That includes primary care doctors, nurse practitioners, physician assistants, and psychiatrists. You don’t need to see an addiction specialist, though one may be helpful depending on your situation. This is a key difference from buprenorphine (Suboxone), which historically had more restrictive prescribing rules.
Your starting point can be as simple as your regular doctor. If you don’t have one, urgent care clinics, community health centers, and telehealth platforms all offer pathways to a prescription. SAMHSA’s treatment locator can help you find providers in your area who work with medication-assisted treatment.
What Happens Before You Get a Prescription
Your provider will screen for a few things before writing the prescription. Expect questions about your liver health, kidney function, current medications, and substance use history. A liver function blood test is standard because naltrexone is processed by the liver, and providers typically recheck liver enzymes within three months of starting the medication.
If you’re taking naltrexone for opioid use disorder, timing matters. You must be fully detoxified from all opioids before your first dose. The minimum waiting period is 7 days after your last use of short-acting opioids (like heroin or oxycodone) and 10 to 14 days for long-acting opioids (like methadone). Taking naltrexone while opioids are still in your system triggers precipitated withdrawal, which is sudden, severe, and dangerous. Your provider will confirm abstinence through a urine drug screen before prescribing.
For alcohol use disorder, you don’t need to be completely sober, but you shouldn’t be physically dependent on alcohol at the time you start. Providers typically wait until after alcohol detox to begin naltrexone, since starting it while your body is still dependent can cause intense nausea and vomiting.
Oral Tablets vs. Monthly Injection
Naltrexone comes in two forms: a daily 50 mg oral tablet and a once-monthly injection sold under the brand name Vivitrol. Both are FDA-approved for alcohol and opioid use disorders.
The oral tablet is the cheaper, more accessible option. With a discount coupon, a 30-day supply of generic 50 mg tablets runs around $30 at most pharmacies, compared to a retail price near $48 to $89 without any discount. You take one pill a day.
The Vivitrol injection is administered by a healthcare provider once every four weeks. It costs significantly more, often over $1,000 per injection before insurance. The advantage is that you don’t have to remember a daily pill, and you can’t skip doses. Research suggests the injectable form may be more effective at reducing heavy drinking episodes, likely because adherence isn’t an issue. If you’re someone who struggles with taking medication consistently, the injection is worth discussing with your provider.
Targeted Dosing for Alcohol Use
Some people use naltrexone specifically before drinking rather than every day. This approach, sometimes called targeted dosing or associated with the Sinclair Method, involves taking a tablet about an hour before you plan to drink. The idea is that blocking the brain’s reward response to alcohol gradually reduces the desire to drink over time.
Research supports this approach. One study protocol used 25 mg taken before anticipated drinking situations, with some participants later moving to a combination of daily and targeted dosing depending on their response. If this method interests you, bring it up with your prescriber. Not every doctor is familiar with it, but any provider who prescribes naltrexone can write the same prescription, since the medication itself is identical. The difference is in how you’re instructed to take it.
Getting Low-Dose Naltrexone (LDN)
Low-dose naltrexone, typically 1.5 to 4.5 mg, is a different situation entirely. It’s used off-label for conditions like fibromyalgia, chronic pain, and autoimmune disorders. Because the FDA-approved tablet is 50 mg, you can’t simply cut it into the right dose. LDN requires a compounding pharmacy to prepare it in the correct strength.
The process works like this: your doctor writes a prescription specifying the low dose, and you take it to a compounding pharmacy rather than a standard retail pharmacy. Local compounding pharmacies typically make LDN in capsule form, while some mail-order compounding companies offer scored tablets. Make sure any compounding pharmacy you use is PCAB accredited (Pharmacy Compounding Accreditation Board), which verifies they meet quality standards.
If your doctor recommends a gradual dose increase, you may need two separate prescriptions: one for a lower starting dose (often 1.5 mg) and one for the target dose of 4.5 mg. A common approach is starting at 1.5 mg at bedtime for one to two weeks, then stepping up. If you’re sensitive to medications, your doctor can extend the ramp-up period. People currently taking any opioid medication need to discuss ultra-low doses (measured in micrograms) with their doctor, since even small amounts of naltrexone can interfere with opioid pain relief.
Telehealth and Online Prescriptions
Telehealth has made naltrexone easier to access, especially if you live in an area with few addiction medicine providers or simply prefer the privacy of a virtual visit. Several online platforms now offer naltrexone prescriptions after a video consultation. Initial telehealth assessments typically cost between $50 and $150 per visit.
The process mirrors an in-person visit: you’ll answer screening questions, discuss your health history, and if appropriate, receive a prescription sent electronically to your pharmacy. Some platforms specialize in alcohol use disorder treatment and include ongoing check-ins as part of their service. Others are broader telehealth providers who can prescribe naltrexone alongside other medications. If you need the Vivitrol injection, you’ll still need to visit a clinic or provider’s office for the actual shot, but the initial evaluation and prescription can happen virtually.
Insurance and Out-of-Pocket Costs
Generic oral naltrexone is one of the more affordable prescription medications. The retail price for 30 tablets of 50 mg hovers around $48 to $89, but pharmacy discount programs bring that down to roughly $30 without insurance. Most insurance plans and Medicaid cover naltrexone for its approved uses, often with a low copay.
Vivitrol is a different story. The brand-name injection carries a much higher price tag, though the manufacturer offers a copay assistance program for commercially insured patients. Medicaid and many private insurers do cover it, but prior authorization is sometimes required. LDN from a compounding pharmacy is rarely covered by insurance since it’s an off-label use, and you should expect to pay out of pocket, though costs vary by pharmacy.