Naltrexone is a medication prescribed to individuals managing Alcohol Use Disorder (AUD) or Opioid Use Disorder (OUD). This drug supports recovery and reduces the frequency and intensity of substance use. While Naltrexone is intended to be part of a comprehensive treatment plan, the question of what happens when a person consumes alcohol while taking this medication remains frequent. Understanding this interaction requires a look at how the drug works within the brain and the specific physical risks involved. This information clarifies how Naltrexone alters the experience of drinking and what precautions must be taken for safe use.
How Naltrexone Alters the Drinking Experience
Naltrexone fundamentally changes the experience of consuming alcohol by interfering with the brain’s reward system. The drug acts as an opioid receptor antagonist, meaning it competitively binds to and blocks opioid receptors, particularly the mu-opioid receptor. Alcohol consumption triggers the release of endorphins, which activate this reward pathway and generate feelings of pleasure or euphoria.
By blocking these receptors, Naltrexone prevents the endorphins released by alcohol from creating a pleasurable response, effectively dampening the reinforcing “buzz.” This action interrupts the learned connection between drinking alcohol and feeling rewarded, which is often the driver of heavy consumption. Over time, this interruption can lead to pharmacological extinction, where the desire to drink gradually diminishes.
Naltrexone reduces the psychological reward of alcohol, but it does not prevent physical intoxication. The medication has no effect on a person’s Blood Alcohol Content (BAC), nor does it counteract the physical impairment that alcohol causes. An individual taking Naltrexone will still experience poor coordination, slurred speech, and impaired judgment if they drink in excess. The goal is to reduce the motivation to continue drinking by eliminating the associated positive feeling.
Safety Concerns and Adverse Physical Reactions
Combining Naltrexone and alcohol introduces specific safety concerns centered on organ function and the paradoxical risk of severe intoxication. A primary consideration involves the liver, as both alcohol and Naltrexone are metabolized by this organ. Naltrexone carries a caution regarding potential liver strain, especially at high doses or for patients with pre-existing liver conditions like acute hepatitis or liver failure.
For this reason, a healthcare provider will perform liver function tests (LFTs) before starting treatment and monitor them periodically. While the standard 50-milligram dose is generally considered safe, continuing to consume alcohol, particularly in high volumes, increases the overall burden on the organ. Continued heavy drinking while on the medication poses a greater risk of liver damage than the medication itself.
A significant danger arises from the loss of alcohol’s pleasurable effects. Because the euphoric “buzz” is blocked, some individuals may attempt to “drink through” the medication by consuming far greater quantities of alcohol. This behavior can lead to dangerously high Blood Alcohol Content levels without the usual subjective warning signs of feeling “drunk.” This significantly increases the risk of acute alcohol poisoning, severe impairment, and potential death.
Combining the substances can also exacerbate common, milder side effects associated with Naltrexone. These adverse reactions are physical signs that the body is struggling to process both the medication and the alcohol simultaneously. These side effects include:
- Nausea
- Vomiting
- Stomach pain
- Dizziness
- Headache
- Increased fatigue
Guidelines for Safe and Effective Use
Safe and effective use of Naltrexone requires strict adherence to the prescribed regimen and open communication with a healthcare professional. The typical oral dose is 50 milligrams daily, but some patients may use a targeted approach, such as the Sinclair Method, where the pill is taken one hour before any planned drinking event. Consistent adherence is paramount, as skipping a dose before drinking nullifies the extinction effect and restores the full reward pathway.
Patients should maintain regular contact with their prescribing provider, especially if they continue to drink or experience side effects. Report any symptoms of potential liver issues, such as yellowing of the skin or eyes, dark urine, or severe abdominal pain, which may warrant immediate medical evaluation. Adjustments to the dosage or a switch to the injectable form, which is administered monthly, may be considered to improve adherence or manage side effects.
Naltrexone works most effectively when integrated into a comprehensive treatment strategy. This means combining the use of the medication with concurrent psychosocial support, such as counseling, therapy, or support groups. The medication helps reduce the physical craving, but behavioral interventions are necessary to address the underlying psychological and social factors contributing to alcohol use.