What’s It Like to Drink Alcohol While on Naltrexone?

Medically reviewed by John Mendelson, M.D. on

Table of Contents

Often, when people realize they have an unhealthy relationship with alcohol, they delay treatment because they’re not ready to give up drinking.

Treatment for alcohol dependence often involves abstinence-based approaches, such as Alcoholics Anonymous (AA). But at Ria Health, we realize that different treatments work for different people. Sometimes, the treatments that work best are not abstinence-based. One such alternative treatment involves a medication called naltrexone, which allows people to continue drinking in moderation if they so choose.

Because this approach is less well-known, you’ll likely want some answers to your questions before considering this approach. For example, many patients are curious about how drinking feels different while taking naltrexone. In this post, you’ll learn how this medication can change the way you drink by targeting the buzz you get from drinking alcohol.

Read more about Naltrexone for Alcohol Use Disorder

What Is Naltrexone?

If you’ve surfed through our website, you may know that naltrexone is one of the medications our doctors prescribe to help treat alcohol dependence. It’s also sold under brand names ReVia and Vivitrol.

The drug was originally used to treat opioid addictions. This is because naltrexone is an opiate antagonist—which means it blocks the body from responding to opioids and endorphins. When a person uses a drug like heroin, oxycodone, or morphine, naltrexone stops the “pleasure” effects created by the drug.

Researchers eventually realized that the drug can help in a similar way to treat alcohol dependence. A 2013 review of research  found that naltrexone was effective at reducing heavy drinking and cravings.

When you have a drink while taking naltrexone, you won’t feel the same familiar buzz. This helps break the connection your brain has made between drinking and pleasure. When this learned connection stops being reinforced, it can eventually make it easier to cut down or stop drinking.

Research has compared those who take naltrexone to those who just take a placebo (an inactive substance, like a sugar pill). Patients who take naltrexone have fewer drinks and fewer relapse episodes.

If naltrexone is so effective, you’re probably wondering why you haven’t heard much about it until now. After all, it was approved by the Food & Drug Administration (FDA) in 1994 for use in treating alcohol use disorder—but it isn’t as widely talked about as abstinence-based treatments.

Unfortunately, medication-assisted treatment (or MAT) is substantially underused to treat alcohol dependence, according to a 2017 review of research. In fact, researchers concluded that more effort is needed to remove barriers to treatment—which is our goal at Ria Health.

Ria’s at-home program uses naltrexone and other medications as part of our program for alcohol control.

Learn more about Ria’s Program

How Do You Take Naltrexone?

Naltrexone is the generic name of the drug. In tablet form, it’s sold under the brand ReVia.

There is also an extended-release version called Vivitrol that’s injected once a month. But in this section, we’ll be focusing on the oral form.

Naltrexone tablets are prescribed, and the way they are taken may vary by patient, depending on the physician’s instructions. However, people typically take the medication in anticipation of drinking. For example, if you know you’ll be going out for dinner and will want a glass of wine, you’d take a tablet an hour before. If you drink daily, you’ll likely be prescribed one tablet once a day.

If you are abstinent, naltrexone can also help you remain sober.

Your doctor will supervise your treatment to determine how long you should take the medication. Typically, patients see the best results when they take naltrexone as needed for a few months or longer.

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How Does It Feel To Drink After Taking Naltrexone?

Naltrexone is not addictive or psychoactive, meaning that it won’t give you any type of high. This is one of the reasons why it can be a great treatment option. Similar to a vitamin or a supplement, you won’t feel anything when you take it. And if you stop treatment, you won’t suffer any withdrawal symptoms.

Since naltrexone blocks the body from responding to endorphins, you may notice more subdued effects after drinking. For example, after taking a tablet and having your first drink, you may not feel the typical “buzz.” Because you don’t get the “reward” for drinking, your craving for another drink may diminish. Many people say naltrexone lessens their enjoyment around drinking.

To give you a better idea of how naltrexone feels, we’ll let patients put it in their own words. Here are a few excerpts taken from naltrexone reviews on Drugs.com:

  • “I took the pill and of course, with a beer. I didn’t feel like having another beer for several hours. I was so thirsty though and began drinking tons of water that day.”
  • “Day 1 took 50mg, felt a bit strange but then noticed cravings went away.”
  • “I have noticed the buzz is disappearing and it just tastes like, well, nothing really.”
  • “It just is kind of unappealing now… I feel slightly nauseous sometimes but it’s not overwhelming and I’m not eating as much food either.”
  • “The feeling I usually get when I have a drink is ‘full’ and I can drink no more. This has also decreased my cravings greatly.”
  • “I got the script filled (50mg), went home, took it, felt nothing, went to bed. I kept taking it daily, nothing for the first week. But then it occurred to me that I had thought about drinking much less than normal.”

Read more Naltrexone Reviews

Does Naltrexone Work?

Over time naltrexone can help reduce cravings and drinking, but when you take the first tablet, it may not banish cravings immediately. It usually works best over the long term.

Research has shown that for naltrexone to be effective, it’s “extremely important” to take as directed. In three different trials, it only had a positive effect if patients had high medication adherence.

Some people may miss doses because they forget or want to feel more of a buzz when drinking. Unfortunately, even skipping one or a couple could make the next doses less effective. That’s why counseling is beneficial alongside the medication. Our coaches can help you make a plan to stick to your naltrexone schedule.

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How Long Does Naltrexone Block Alcohol For?

Studies show that naltrexone is at its peak an hour after you take it. But how long does the anti-craving effect last?

Compared to many other drugs, naltrexone lasts longer. Its half-life—meaning how long it stays in the body before only half is left—is about 4 to 13 hours. That’s how long you can expect a single dose to be effective for. You can typically take it before drinking and have it last the entire night, which is usually why only one tablet a day is prescribed.

To understand why that half-life range is so large, we need to explain how naltrexone is metabolized. When you take naltrexone orally, it’s metabolized by the liver. During this process, dihydrodiol dehydrogenase enzymes cause a chemical change. This converts naltrexone into 6β-naltrexol. Naltrexone has a half-life of 4 hours. However, studies show that its metabolite (or “by-product”) lasts much longer, up to 13 hours.

Another benefit is that naltrexone is more easily absorbed into the body. When taken orally, drugs go through the “first-pass” effect as they metabolize. Only a certain percentage of any drug is actually circulated—this is referred to as bioavailability. Although naltrexone goes through a large first pass metabolism, 6β-naltrexol allows it to still be well absorbed.

Naltrexone’s longer half-life and good bioavailability make it an effective choice for those looking for medical alternatives for alcohol addiction treatment.

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How Long Does Naltrexone Last in the Body?

It’s important to note that although it’s not effective after its half-life, it doesn’t mean the entire dose has left your body after 13 hours. It generally takes a few half-lives until naltrexone is fully eliminated.

How long it stays in your body depends on a few factors, such as:

  • Metabolism— Bodies with faster metabolisms will eliminate drugs quicker.
  • Weight— Having a higher percentage of fat can affect medication distribution and metabolism.
  • Age— Younger bodies typically process drugs faster.
  • Health— Some health issues such as chronic illnesses can affect how long drugs stay in the body.
  • Hydration Studies show that dehydration may significantly slow the time it takes to clear the body of a medication.

Careful, You May Still Be Drunk

It’s important to note that naltrexone doesn’t stop impairment. Most people who take naltrexone still experience a sense of intoxication when they drink—they just don’t experience the same “reward” from that intoxication. In other words, you can still get drunk on naltrexone, and experience impaired coordination or judgement—you just might not enjoy it as much.

It goes without saying, therefore, that you shouldn’t drive when drinking on naltrexone, or perform any other activity that requires good coordination and judgement. It’s important to take the usual safety precautions if you consume alcohol.

Some medications cannot be taken while drinking because they don’t interact well with alcohol. However, doctors prescribe naltrexone to use when you anticipate drinking, so it will not cause any negative effects when combined. In terms of drug interactions, however, naltrexone should not be taken if you are prescribed opioid pain medication, as it will block that medication from working.

A 2017 review of research concluded that there were only a few safety concerns with using medication to treat alcohol dependence. The main issue to be aware of is whether or not you have liver disease. Since naltrexone is processed through the liver, other medications such as baclofen may be a better choice in that case.

Otherwise, side effects of taking naltrexone are relatively rare. According to research, the number of people who experience side effects or stop treatment due to them is about the same number as those who are given a placebo.

The most commonly reported side effects include nausea, headaches and dehydration.

Although less common, you may experience:

  •   Fatigue
  •   Insomnia
  •   Vomiting

In most cases, these effects are mild and only occur before your body gets used to the medication.

Read more: Dr. John Mendelson answers common questions about naltrexone side effects

Summary of Drinking Alcohol on Naltrexone

When someone takes naltrexone for alcohol addiction, their healthcare provider may recommend using the Sinclair Method. This typically requires you to take a tablet an hour before drinking. Many people wonder how the combination will feel. The most notable effect is that it takes away alcohol’s buzz. Other than that, many patients don’t feel anything. However, over time, they’ll notice that their cravings diminish. Some people may experience side effects as their body gets used to naltrexone. The drug also does not stop impairment, even though you may not feel drunk.

Many Ria Health members are able to reduce their drinking after treatment with naltrexone. Ria’s program combines medicine and technology to provide a personalized and complete treatment program. After a consultation with our medical team, you’ll receive a prescription, and with the Ria Health app, you’ll be able to set goals and monitor progress. As the months go by, your treatment will be adjusted if needed, and you’ll learn healthy habits.

If you’d like more information on our program, schedule a call with one of our counselors, or read more about how it works.

Written By:
Riannon Westall
Toronto-based health writer. Background in newsroom journalism, content marketing, and research.
Reviewed By:
Evan O'Donnell
NYC-based content strategist with over 3 years editing and writing in the recovery space. Strong believer in accessible, empathic, and fact-based communication.
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