Naltrexone: Uses, How It Works, Side Effects, and What to Expect

Naltrexone blocks opioid receptors. It can help some people cut back on heavy drinking, and it helps prevent a return to opioid use after opioids have been safely stopped. Here is what the FDA labels support, what the newer research shows, and what to ask before you start.

What to know

• Naltrexone is FDA-approved for alcohol use disorder and, after detox, for opioid use disorder. It comes as a daily tablet (commonly 50 mg) and as Vivitrol, a 380 mg injection given every four weeks or once a month.[1,2]
• It is not addictive and does not cause a high, but it can trigger sudden, severe withdrawal in anyone still physically dependent on opioids, including tramadol and possibly kratom.[1,4,57]
• Opioid-free timing matters. Labels recommend at least 7 to 10 opioid-free days after short-acting opioids, and people switching from methadone or buprenorphine may be vulnerable for as long as two weeks.[1,2]
• The alcohol benefit is real but moderate. In the pivotal injection trial, the 380 mg dose reduced the rate of heavy-drinking days by 25% compared with placebo.[15]
• It is not an overdose antidote. Naloxone (Narcan) reverses overdose; naltrexone does not, and overdose risk can rise after treatment stops.[2,6]
• Low-dose naltrexone (LDN) is off-label and mostly compounded. Recent placebo-controlled fibromyalgia trials, including the 2026 INNOVA study, did not show a meaningful pain benefit.[8,33]

Zoom

Why the reason for treatment matters

If you were offered naltrexone, the first useful question is: “What are we treating, and how will we know this is helping?” The answer matters because the evidence, dose, and safety plan depend on the reason for treatment. A low-dose prescription for pain does not have the same evidence as treatment for alcohol use disorder.

This guide explains the main uses, the claims you may hear about other uses, and the questions to bring to your care team. It provides general education. It cannot decide whether you should start, stop, or change a medicine.

Key safety facts before you start

Naltrexone does not produce an opioid high or cause opioid dependence of its own. It can, however, trigger severe withdrawal if your body is still dependent on an opioid. Tell the prescriber about every medicine, supplement, and drug you use, even if naltrexone is being prescribed for drinking or pain.[1,4]

Naltrexone does not treat alcohol withdrawal, prevent intoxication, or make it safe to drive after drinking. It is also not an emergency overdose treatment. Opioid overdose remains possible during treatment and after it ends.[2,5,6]

Treatment works best when the plan fits your goals, health, and daily life. Medicine can accompany counseling, medical care, and recovery support. You do not have to prove that you have enough willpower to deserve help.[7]

Naltrexone forms: tablets, Vivitrol, Contrave, and LDN

These examples describe products, not doses for you to follow. Your prescription and product instructions control your care. The forms are not interchangeable.[1,2,3,4,8]

You may see the older brand name Revia online. Revia 50 mg tablets were withdrawn from sale, and in April 2026 the FDA determined that they were not withdrawn for reasons of safety or effectiveness. That decision allows generic naltrexone tablets that reference Revia to stay on the market. Pharmacy supply can still change.[9]

How naltrexone works in the brain

Receptors are places on cells where chemical signals attach. Opioid medicines, heroin, and the body’s own opioid signals act at opioid receptors. Naltrexone occupies these sites and blocks some of those signals, especially at the mu opioid receptor. The word “antagonist” means a blocker.[1,2]

You can think of a receptor as a docking site. Naltrexone sits there without producing the usual opioid effect. That can reduce the effects of an opioid someone takes. The analogy has a serious limit: blockade is not a shield against overdose. Taking more opioids to try to get past it can be fatal.[4]

Alcohol can activate the body’s opioid system as part of its rewarding effects. By blocking that system, naltrexone may make drinking less rewarding and reduce the pull to continue. The full alcohol mechanism is still not completely understood. It does not directly block all dopamine activity or erase the many reasons people drink.[7,2]

The liver processes oral naltrexone, creating an active breakdown product called 6-beta-naltrexol. The injection releases medicine over weeks. How long a drug stays in the blood is not the same as how long its receptor effects last. Those differences matter when a clinician plans pain treatment or a change in medicines.[1,4]

Low-dose naltrexone has additional proposed mechanisms involving immune signaling and the brain’s support cells. Researchers have discussed microglia, Toll-like receptor 4, and changes in the body’s opioid signals. Much of this explanation comes from laboratory research or theory. A plausible mechanism does not show that a treatment improves pain, fatigue, or an autoimmune disease in people.[10,11,12,13]

Naltrexone for alcohol use disorder

Alcohol use disorder means drinking has become hard to control or continues despite harm. The harm may involve health, work, family life, or safety. Naltrexone can be part of treatment whether the person arrives with a firm goal to stop or needs help discussing how to change. The right goal also depends on withdrawal risk and other medical conditions.[7]

How well naltrexone works for drinking

The best-supported benefits involve reducing heavy drinking and the chance of returning to heavy drinking. Some people notice less craving or find it easier to stop after a drink. Others get limited benefit or have side effects that make a different plan more useful.

In the 16-week COMBINE trial, one comparison found about 81% of days without drinking with naltrexone, versus about 75% without it. Both groups received structured medical management. This was the share of days, not the percentage of people who stayed fully sober. The comparison combined groups with and without another study medicine and excluded the intensive behavioral-treatment groups. The trial used 100 mg daily; this is not a personal dosing instruction.[14]

In a pivotal six-month injection trial, the approved 380 mg dose reduced the rate of heavy-drinking days by 25% relative to placebo. That does not mean one in four people was cured, or that every person drank 25% less. Both groups also received supportive care.[15]

These results show why a treatment can be worth trying without being a cure. The most useful outcome for you might be fewer dangerous drinking episodes, better sleep, safer relationships, or sustained abstinence. The team should track the goal you agreed on and whether the benefit outweighs the burden.

Starting naltrexone tablets or the Vivitrol injection

An important distinction often gets lost online. Oral naltrexone can sometimes be started while a person is still drinking, after the clinician checks withdrawal risk and other safety issues. The Vivitrol label says patients should be able to abstain before treatment and should not be actively drinking when the first injection is given.[16,2]

Neither approach treats dangerous alcohol withdrawal. If you need alcohol to stop shaking, have had a withdrawal seizure, or become confused or very ill when you cut down, seek medical advice before making a sudden change. Naltrexone does not make a home detoxification safe.[16]

It is different from disulfiram, which can cause a dangerous unpleasant reaction when alcohol is consumed. Naltrexone does not cause that same reaction. You can still become intoxicated and experience alcohol-related harm while taking it.[7,5]

Daily tablets and targeted (as-needed) use

Some studies have tested taking oral naltrexone around anticipated drinking rather than every day. A randomized trial in a selected group of men with mild to moderate alcohol use disorder found fewer reported binge-drinking outcomes with targeted treatment. It did not show improvement in every drinking measure. The participants also received counseling.[17]

You may hear this discussed as the Sinclair Method. Evidence for selected targeted regimens does not prove claims of a permanent cure or make every online schedule appropriate. Timing, treatment goals, opioid exposure, and withdrawal risk need a prescriber’s review. Do not use this article to plan drinking and dosing on your own.

Naltrexone tablets vs. Vivitrol injection

The monthly injection can help when remembering a tablet is difficult. Tablets allow daily use without an injection visit and may be easier to adjust under supervision. The injection adds appointment, administration, and cost issues, and it continues working after it has been given.

The 2025 ADOPT randomized trial found substantial improvement in both groups after hospitalization, without a statistically clear difference in reduction of heavy-drinking days between oral and injectable treatment at three months. The study does not prove the forms are identical for every person. It supports choosing based on access, preference, adherence, and clinical needs.[18]

Other medicines for alcohol use disorder

Acamprosate is another approved option, often used to support abstinence after withdrawal; kidney function matters. Disulfiram requires avoiding alcohol and has different safety concerns. Other medicines, such as topiramate or gabapentin, may be considered off-label in selected cases. A person needing opioid pain treatment may need an alcohol-treatment option that does not block opioids.[7,16]

If naltrexone is not helping enough, tell the team. Changing the plan can mean another medicine, more support, treatment of depression or trauma, or a different level of care. A return to drinking is a reason to reassess safety and treatment.

Naltrexone for opioid use disorder

Naltrexone can support relapse prevention after opioids have been stopped and the clinician has confirmed that starting an opioid blocker is safe. The monthly injection is a common formulation for this purpose. Oral naltrexone also has a labeled opioid-blockade role, but taking it consistently has been a major challenge in opioid treatment.[1,4]

The hardest part can be getting safely to the first dose. A person who is physically dependent on an opioid cannot simply switch to naltrexone the next day. Waiting through withdrawal can be difficult and can create a risk of returning to opioid use. Specialist programs have studied faster starts with close monitoring; those methods are not home instructions.[4,19]

The X:BOT trial illustrates this problem. About 72% of participants assigned to injectable naltrexone started it, compared with about 94% assigned to buprenorphine with naloxone. Looking at everyone assigned to treatment, more people in the naltrexone group returned to opioid use. Among those who successfully started medication, the treatment outcomes were similar. Leaving out the people who could not start would miss an important part of the decision.[20]

Buprenorphine and methadone work differently. They activate opioid receptors in controlled ways and have strong roles in treating opioid use disorder. Taking them as prescribed is medical treatment. Naltrexone’s lack of an opioid effect does not make it the best or safest choice for everyone.[4]

Overdose and survival are separate outcomes from craving or return to use. Research gives methadone and buprenorphine stronger evidence for lowering death risk. A 2026 observational comparison found fewer nonfatal overdoses after buprenorphine-naloxone than after injectable naltrexone, with no clear difference in death rates. Other comparative findings have differed. These studies cannot prove equal protection or decide the best treatment for every person.[21,22,23]

Treatment choice should consider what can be started safely now, what has helped before, pain needs, pregnancy, access, and the person’s preference. Staying connected to effective treatment matters more than choosing a medicine because it seems more morally acceptable.

Overdose prevention remains essential. Do not test whether opioids “work” on naltrexone. After time away from opioids, tolerance can fall. A previously used amount can become fatal, especially when an injection wears off, an appointment is missed, or treatment stops. Make a plan for access to overdose reversal medicine and teach close support people how to respond.[24,6]

Naltrexone with bupropion (Contrave) for weight management

Contrave combines naltrexone with bupropion. It is approved with a reduced-calorie eating plan and physical activity for adults with obesity, or overweight with a weight-related health condition. This approval belongs to the combination product. It does not mean naltrexone alone is an approved weight-loss medicine.[3]

The combination is thought to affect appetite and reward pathways. In the 56-week COR-I trial, the main analysis found average weight loss of 6.1% with the higher-dose combination versus 1.3% with placebo. Many participants did not complete the study, and both groups received lifestyle advice. These are averages, not promised personal results.[25]

Bupropion adds risks that require a separate assessment. Important concerns include seizure disorders, uncontrolled high blood pressure, anorexia or bulimia, other bupropion prescriptions, some drug interactions, and mood changes. The product carries an antidepressant-related boxed warning about suicidal thoughts and behavior. It is not approved to treat depression.[3]

Contrave’s label says to discontinue it when pregnancy is recognized. Contact the prescriber promptly to plan ongoing care. Do not assume that a separate naltrexone-bupropion study uses the same product or schedule as Contrave.[3]

Off-label uses and what the evidence means

An “off-label” prescription uses a medicine outside its approved labeling. This can be a reasonable clinical choice in some situations. The useful question is how strong the evidence is for the exact condition, formulation, and outcome.

The table is a map of evidence, not a list of treatments to request.[1,2,3,26,27,28,29,30,31,32,8,33,34,35,36,37]

Methamphetamine use disorder

The ADAPT-2 trial studied extended-release injectable naltrexone plus extended-release bupropion. The weighted response was 13.6% with the combination and 2.5% with placebo. “Response” meant at least three negative methamphetamine urine tests out of four near the end of a study stage. It did not mean permanent recovery.[26]

ASAM and AAAP give this combination a conditional recommendation for selected people with amphetamine-type stimulant use disorder. It remains off-label. It is not the same regimen as the weight-management product, and the evidence does not establish naltrexone alone as a broadly effective stimulant treatment. Contingency management, which uses agreed rewards for treatment goals, has an important evidence-based role.[27]

Gambling, binge eating, and compulsive behaviors

Some gambling trials have found reduced urges and symptoms with daily naltrexone. An as-needed trial did not find a clear advantage over placebo. These mixed results are a reason to discuss the exact approach and accompanying psychological treatment.[28,29]

For gambling specifically, the United Kingdom’s January 2025 NICE guideline on gambling-related harms supports considering specialist-supervised naltrexone when an adequate course of psychological therapy has not worked or relapse keeps occurring. NICE notes that this is off-label, and it recommends considering continued psychological therapy alongside the medicine.[38]

In a 2023 binge-eating trial, naltrexone with bupropion improved weight outcomes but did not outperform placebo for binge frequency or binge remission. Treating weight and treating an eating disorder are different goals.[30]

Small studies have also examined kleptomania, compulsive sexual behavior, hair pulling, and some forms of self-injury. Results differ by condition, and several findings are negative or uncertain. These uses do not make naltrexone a general treatment for compulsive behavior, and self-injury needs careful assessment of its cause and immediate safety.[39,40,41,42]

Itching and skin disease

A small trial supports a possible role for naltrexone in itching caused by impaired bile flow, called cholestatic pruritus. A trial for kidney-related itching did not show benefit. A few dermatologic uses rely mostly on case reports, while a trial in lichen planopilaris did not show superiority. The cause of the symptom matters. Specialist assessment should come before trying an opioid blocker for itching.[31,32,43,44]

Low-dose naltrexone (LDN) and the claims around it

LDN usually means doses much lower than the standard addiction-treatment tablet. Many trials have used roughly 1 to 6 mg daily, but there is no single definition or approved universal schedule. A compounded product is made for a prescription; FDA does not approve that individual compounded product for safety and effectiveness as it does an approved drug product.[8,33,45]

Lower doses are not automatically free of side effects or opioid interactions. LDN studies have reported sleep disturbance, vivid dreams, headache, and nausea. The quality of a compounded preparation and the reason for using it should be part of the discussion. Do not make your own preparation from tablets.[33,34]

LDN for fibromyalgia and chronic pain

Early, small fibromyalgia studies suggested that LDN might reduce pain. Later placebo-controlled trials in 2023 and 2024 did not show the expected pain advantage. The 2026 INNOVA study followed 98 women for up to a year and also found no clinically meaningful benefit over placebo on its main pain outcomes.[46,47,8,33]

This does not mean every person who reports improvement is mistaken. It means the stronger evidence has not shown reliable benefit for the average patient in those studies. A change in pain can have several causes, including other treatment, natural fluctuation, expectations, and the medicine itself. Trials help separate those possibilities.

A 2026 re-analysis also challenged an earlier positive pooled analysis. Some response findings remained positive, but the re-analysis of pain scores did not show a clear benefit. A review is only as reliable as its included trials and calculations.[48]

Pain conditions also differ. A result in one type of nerve pain cannot prove benefit for arthritis, pelvic pain, or complex regional pain syndrome. An arthritis trial was negative, and other areas have small or limited studies. LDN should not be described as a proven treatment for chronic pain as a whole.[49,50]

LDN for Crohn’s disease and multiple sclerosis

An early, small randomized Crohn’s disease trial reported encouraging findings. A small multicenter Dutch trial published in 2026 (41 randomized) stopped early for futility. It showed no endoscopic benefit, and clinical remission was actually more common with placebo. A fatigue improvement was a secondary finding. It did not establish healing of intestinal disease.[51,34]

In multiple sclerosis, short trials have examined quality of life and symptoms, with conflicting results. They do not establish that LDN prevents relapses, changes MRI findings, or slows disability. It should not replace established disease-modifying care.[52,35]

ME/CFS, long COVID, cancer, and autism claims

Reports in ME/CFS and long COVID are mainly small, uncontrolled, or retrospective. They provide reasons to study LDN, but cannot establish that it caused improvement. A completed randomized trial of LDN for post-COVID fatigue (NCT05430152) had no results posted in its registry when checked for this article.[37,36,53] In August 2026, the ME Association, which funded a Canadian LDN trial led by Dr. Luis Nacul, reported that its preliminary results, discussed at a conference earlier in 2026, were negative and are being submitted for publication. Full published results were not available for this guide. A registered trial alone is not evidence of benefit.[54]

LDN is not an established cancer treatment. A placebo-controlled glioma study did not show benefit for fatigue or quality of life; it was not evidence of an anticancer effect. Older autism studies used different doses and generally examined selected behaviors. They do not establish LDN as treatment for core autism features or justify claims of a cure.[55,56]

If an experimental prescription is considered, ask what symptom it targets, how progress will be measured, what alternatives exist, and when the trial of treatment will be reassessed. For psychiatric uses specifically, see our comprehensive guide to low-dose naltrexone in psychiatry.

What your clinician checks before starting naltrexone

Bring a full list of prescriptions, over-the-counter medicines, supplements, alcohol, and other substances. Include the last time you used an opioid and any planned surgery or dental work. The team also needs to know about liver or kidney disease, pregnancy, breastfeeding, allergies, and mood symptoms.

An assessment may include a physical examination, laboratory tests, and opioid testing. The exact plan depends on the product, reason for treatment, and your health. A normal test result does not replace a complete history.

Recent opioid use and precipitated withdrawal

Relevant drugs include fentanyl, heroin, oxycodone, hydrocodone, morphine, codeine, tramadol, methadone, and buprenorphine. Some cough, cold, and diarrhea medicines also contain opioids. Tell the clinician about kratom and concentrated opioid-like products too. Severe withdrawal after naltrexone has been reported with kratom use.[4,5,57]

“Precipitated withdrawal” means a blocker suddenly pushes someone into withdrawal while their body is still dependent on opioids. Symptoms can include intense distress, vomiting, diarrhea, sweating, cramping, and agitation. Severe cases may need hospital care.[1]

Labels commonly recommend at least 7 to 10 opioid-free days after short-acting opioids. People switching from methadone or buprenorphine may remain vulnerable for as long as two weeks. These intervals are not a home readiness test; the exposure, timing, and individual health can change the assessment.[1,2,4]

Urine tests do not detect every substance in every situation. Even a negative test or a tolerated clinician-administered naloxone challenge cannot guarantee a safe start. Do not perform your own test dose or stop established opioid treatment to try naltrexone without a supervised plan.[1]

Naltrexone and liver or kidney health

Naltrexone labels warn about hepatitis and other liver problems. The clinician should consider your liver history, current symptoms, test results, and other possible causes of liver injury. Seek prompt medical advice for yellow skin or eyes, dark urine, or persistent upper abdominal pain.[5]

Having liver disease is not enough, by itself, to answer whether naltrexone is appropriate. A large observational study of 3,285 people with cirrhosis who started naltrexone, mostly involving oral treatment, found no cases classified as possible or more likely naltrexone-related liver injury among the 2,940 who had follow-up liver tests. That is reassuring but cannot prove zero risk.[58]

A 2026 randomized trial of 100 people with compensated alcohol-related cirrhosis found higher 12-week abstinence with 50 mg oral naltrexone than with placebo (64% vs. 22%). However, two of 50 naltrexone patients developed jaundice while continuing to drink. The researchers could not rule out drug-related liver injury. Neither study establishes safety in acute hepatitis, every form of advanced liver disease, or every patient.[59]

Baseline and follow-up testing should follow the clinician’s assessment and relevant guidance. There is no single laboratory schedule that fits every formulation and patient. Kidney disease also needs review because the drug and its breakdown products are cleared in part through the kidneys.[4]

Pregnancy, breastfeeding, and younger patients

Pregnancy changes the treatment discussion. Human safety evidence remains limited; it cannot settle the risks of birth defects, miscarriage, or other pregnancy problems.[2] Starting naltrexone for opioid use disorder during pregnancy is different from continuing medication that is already working. Stopping effective treatment can carry risks, including a return to opioid use. Methadone and buprenorphine have established roles in pregnancy. Decisions about naltrexone need addiction and pregnancy expertise; do not abruptly stop a working plan yourself.[60]

Naltrexone and its metabolite can enter breast milk. Small studies suggest low infant exposure, but do not prove long-term infant safety. LactMed and breastfeeding specialists support breastfeeding when maternal treatment is needed. The current Vivitrol Medication Guide instead tells patients to talk with their provider about whether to breastfeed or take Vivitrol, and says not to do both. These instructions differ. Review treatment and feeding together with your prescriber and the infant’s clinician before changing either.[61,62,24]

Safe oral naltrexone use below age 18 has not been established. Vivitrol’s safety and effectiveness in children have not been established. Prescribing for these age groups requires an individual discussion about evidence and off-label status. Older adults may also need extra attention to kidney function, other medicines, and side effects.[1,2]

Naltrexone side effects and when to get help

Common side effects can include nausea, headache, dizziness, tiredness, vomiting, or trouble sleeping. Oral and injectable products can have different patterns. A sore injection site is common, but a worsening reaction should not be dismissed as ordinary soreness.[5,63]

Tell the prescriber about side effects that interfere with eating, sleep, work, or taking the medicine. A clinician may discuss taking an oral dose with food or another supervised adjustment. Do not change the dose yourself. If you are dizzy or drowsy, avoid driving or hazardous tasks until you know how the medicine affects you.

Get help promptly

Call 911 for trouble breathing, inability to wake up, suspected overdose, collapse, a seizure, or a severe allergic reaction such as swelling of the face or throat. Give an available opioid overdose reversal medicine according to its instructions if overdose is suspected. Follow the dispatcher’s directions for breathing support or CPR, and stay with the person. Improvement after reversal medicine does not remove the need for emergency care.[6]

Seek urgent assessment for severe vomiting or diarrhea after a dose, new yellow skin or eyes, or worsening injection-site pain, swelling, blisters, an open wound, or a dark scab. Rare lung reactions have also been reported with injectable naltrexone; new significant shortness of breath needs medical attention.[2,5,63]

Report new or worsening depression, suicidal thoughts, or marked behavior changes promptly. In the United States, call or text 988 for suicide or emotional-crisis support. Call 911 when there is immediate physical danger or a medical emergency. A report of a mood problem does not establish that the medicine caused it, but it still deserves care.[24,64]

Make an overdose response plan

Naltrexone and naloxone have similar names but different jobs. Naltrexone supports ongoing treatment. Naloxone is used to reverse an opioid overdose. Other approved reversal products also exist, with their own age and product instructions.

Discuss access to reversal medicine when treatment starts and as it continues. Support people should know where it is kept, recognize slow or stopped breathing, and know to call 911. Never assume someone taking naltrexone is protected from overdose.[6]

Pain, surgery, and other medicines

Tell every treating clinician that you take naltrexone, including dentists, surgeons, emergency clinicians, and anesthesiologists. An opioid pain medicine may not work as expected. An injection can keep affecting pain care for weeks.

For planned procedures, the prescribing and anesthesia teams can decide whether an interruption is needed, how pain will be treated, and when it is safe to restart. Restarting after opioid pain treatment requires another safety assessment. Do not use a standard interval from the internet as your own stopping schedule.[65]

Nonopioid medicines and regional anesthesia may be useful. Opioid treatment during active blockade requires a monitored medical setting with staff trained to manage breathing problems. Do not take extra opioids at home to overcome the blockade. Keeping a medication card or an updated phone medication list can help communicate the issue.[1,2]

Ask a pharmacist to check your full list. Do not assume every antidepressant interacts dangerously with naltrexone, but do not assume every combination is harmless. Contrave requires a separate review because bupropion adds interaction, seizure, and blood-pressure concerns. Alcohol and other substances can add risks even when there is no direct drug interaction.

What everyday treatment can look like

For tablets, agree on a routine that fits your day and on what to do if a dose is missed. Use the prescription instructions rather than doubling a dose to catch up. For injections, arrange the next appointment before leaving and contact the clinic promptly if it will be delayed. New opioid use or a long gap may change the restart assessment.[5,63]

A clinician may sometimes assess oral tolerability before an injection, but the Vivitrol label does not require oral pretreatment for everyone. The injection must be prepared and given by a healthcare professional.[2]

Medication effects and meaningful changes in drinking or drug use run on different timelines. At follow-up, review craving, use, side effects, missed doses, sleep, mood, and daily functioning. A tracking plan might record drinking days, heavy-drinking episodes, or the recovery goal you chose. A blood or urine test is one part of that picture.

Duration is individualized. Treatment may continue for months or longer while it is useful. There is no fixed date when every person should stop. Before stopping, discuss current risk, support, other medicines, and what happens if cravings or opioid exposure return.[4]

Oral naltrexone does not usually require tapering to prevent a withdrawal syndrome caused by naltrexone itself. That does not make an unplanned stop risk-free: treatment benefit may be lost, and opioid tolerance and overdose risk need attention. An injection gradually wears off; it cannot be removed to reverse the decision.[1,4]

Costs vary. Ask separately about medicine, injection administration, office fees, pharmacy coverage, and prior authorization. Compounded LDN coverage may be different. A quoted price for the drug alone may not reflect the total visit cost.

How families and support people can help

Ask the person what support would be welcome. Useful help may include transport to appointments, a reminder they agreed to, help organizing questions, or making the home less centered on alcohol or drugs. Respect privacy and control over treatment decisions.

Learn the medication’s main safety issues, especially opioid exposure and overdose response. If appropriate, practice locating reversal medicine and reviewing its instructions together. Help the person contact the team early when side effects, cravings, or missed treatment become a problem.

After a return to use, start with safety. Check whether urgent help is needed and encourage contact with the care team. Blame or surveillance can make honest reporting harder. The next visit can look at stress, pain, sleep, mental health, access, and whether treatment needs to change.

Families also deserve support. You can set clear safety boundaries while remaining respectful. Supporting recovery does not require taking sole responsibility for another person’s medication or behavior.

Frequently asked questions

Is naltrexone addictive?

Naltrexone does not produce an opioid high or cause opioid dependence of its own. A medicine can still require careful monitoring even when it is not addictive. Opioid use before starting can make it dangerous.[1]

How is naltrexone different from naloxone (Narcan)?

Naloxone is an emergency opioid overdose reversal medicine. Naltrexone is longer-term treatment. Do not give a naltrexone tablet to someone who may be overdosing; call 911 and use an available approved reversal medicine according to its instructions.[6]

Can I still get drunk while taking naltrexone?

Yes. Naltrexone does not remove alcohol’s effects on judgment, balance, breathing risks, or driving safety. It is intended to help change drinking outcomes, not make drinking harmless.[5]

Does alcohol withdrawal need separate treatment?

Yes. Naltrexone does not treat alcohol withdrawal. A person with a history of severe withdrawal, seizures, or symptoms relieved by drinking needs a medical assessment before cutting down abruptly.[16]

Does recent tramadol or kratom use matter?

Yes. Tramadol has opioid activity, and some kratom products do too. Tell the prescriber exactly what you used and when. Do not rely on a negative routine urine screen to decide a dose is safe.[4,57]

Does everyone need the injection?

No. Tablets and injections have different burdens and benefits. The choice depends on the condition, safety, adherence, access, and your preference. The injection is not automatically more effective for every person.[18]

How quickly should naltrexone help?

Drug action begins before a full pattern of recovery can be judged. The team should agree on an assessment period and measurable goals. Persistent cravings or continued use are reasons to contact the team, not to increase a dose yourself.

What if I miss a tablet or an injection?

Follow the exact prescription or product instructions, and ask the pharmacist or clinic if uncertain. Do not double tablets. Contact the injection clinic promptly after a missed appointment, especially if opioid exposure has occurred.[5,63]

Can naltrexone cause depression?

Mood symptoms and suicidal thoughts need prompt attention. They can relate to the illness, recovery, other medicines, or treatment.[24] Naltrexone is not an approved antidepressant; a small 2026 trial did not find added antidepressant benefit from LDN.[66]

Does liver disease rule out naltrexone?

Not every liver condition has the same risk. The exact product, disease severity, symptoms, laboratory results, and alternatives matter. Discuss the balance with the prescriber; research in selected cirrhosis populations is not a blanket safety guarantee.[58,59]

Is low-dose naltrexone proven for pain?

It is not a proven general chronic-pain treatment. Later fibromyalgia trials have not confirmed clinically meaningful pain benefit over placebo. Evidence for other pain conditions must be judged separately.[8,33]

Does naltrexone alone cause weight loss?

Weight-management approval and pivotal evidence concern the naltrexone-bupropion combination. They do not establish the same result for naltrexone alone or show that weight loss will treat binge-eating disorder.[25,30]

Will naltrexone take away ordinary pleasures?

Naltrexone’s receptor action does not mean every source of enjoyment will disappear. Still, changes in mood, motivation, or enjoyment should be discussed rather than dismissed. Your clinician can check depression, sleep, recovery, other medicines, and whether the treatment fits you.

Can I have surgery while taking naltrexone?

Yes, but the team needs to know about naltrexone early. Pain treatment and any planned interruption or restart need coordination. In an emergency, tell the treating team the formulation and date of the last dose or injection.[65]

Do I have to stop naltrexone if I become pregnant?

Do not make that decision from this article. Contact your prescriber promptly. The reason for treatment matters: weight-loss treatment has different instructions from ongoing treatment for opioid use disorder, where abruptly losing effective care can be risky.[3,60]

Does a lapse mean treatment failed?

A lapse means the plan needs a safety check and a closer look. The next step may be more support, better access, another medicine, or treatment of a problem that has been missed. Contact the care team rather than hiding the episode or changing medication alone.

Questions to bring to your prescriber

• What exact condition and outcome are we treating?
• Why does this formulation fit my health and goals?
• What recent opioid or supplement exposure could make starting unsafe?
• What should I do about side effects, a missed dose, or a delayed injection?
• How will we measure benefit, and when will we reassess?
• What is my plan for injury, surgery, or dental pain?
• What should my family know about overdose and urgent symptoms?
• If this is off-label, what evidence supports it and what are my alternatives?

Bring the medicine list, your main concerns, and the outcome you want to improve. For more education, explore the related NP FADY guides below.

Related reading on NP FADY

• Alcohol use disorder treatment options
• How alcohol affects the brain
• Treating kratom dependence and addiction
• Binge eating is not a willpower problem
• Low-dose naltrexone (LDN) in psychiatry
• Your body makes its own opioids

Educational disclaimer

This article is for education. It does not diagnose any condition, choose a medication for anyone, or replace the judgment of the clinician who knows your history. Do not start, stop, or change any medication without your prescriber. If there is imminent danger, or you cannot keep yourself or someone else safe, call 911 or go to the nearest emergency department. In the United States, call or text 988, or chat at 988lifeline.org, for any mental-health crisis. For a suspected overdose or accidental ingestion, call Poison Help at 1-800-222-1222. Regulatory and numeric claims in this article were checked against current FDA labeling and primary studies on September 30, 2026. Labels, approvals, and availability change; confirm current status with your prescriber or pharmacist before acting on anything here.

References

1. Elite Laboratories, Inc. Naltrexone Hydrochloride Tablets, USP: Prescribing Information. 2026. Revision May 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5f188bdc-2009-43aa-ad32-f06dbfac2642 Accessed 2026-09-30.
2. Alkermes, Inc. VIVITROL (naltrexone for extended-release injectable suspension): Prescribing Information and Medication Guide. Prescribing information revised May 2026; Medication Guide revised December 2025; DailyMed label version May 31, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cd11c435-b0f0-4bb9-ae78-60f101f3703f Accessed 2026-09-30.
3. Nalpropion Pharmaceuticals LLC (labeler); Currax Pharmaceuticals LLC (distributor). CONTRAVE (naltrexone hydrochloride and bupropion hydrochloride) extended-release tablets, for oral use. 2025. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=485ff360-32c8-11df-928b-0002a5d5c51b Accessed 2026-09-30.
4. Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder, Chapter 3C: Naltrexone. 2021. https://www.ncbi.nlm.nih.gov/sites/books/NBK574913/ Accessed 2026-09-30.
5. American Society of Health-System Pharmacists; hosted by NIH/NLM MedlinePlus. Naltrexone: MedlinePlus Drug Information. 2026. Revision 09/15/2026. https://www.medlineplus.gov/druginfo/meds/a685041.html Accessed 2026-09-30.
6. Centers for Disease Control and Prevention. 5 Things to Know About Naloxone. 2024. Revision May 2, 2024. https://www.cdc.gov/overdose-prevention/reversing-overdose/about-naloxone.html Accessed 2026-09-30.
7. National Institute on Alcohol Abuse and Alcoholism. Recommend Evidence-Based Treatment: Know the Options. Current live resource. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/recommend-evidence-based-treatment-know-options Accessed 2026-09-30.
8. Due Bruun K et al. Naltrexone 6 mg once daily versus placebo in women with fibromyalgia: a randomised, double-blind, placebo-controlled trial. 2024. DOI: 10.1016/S2665-9913(23)00278-3. https://pubmed.ncbi.nlm.nih.gov/38258677/ Accessed 2026-09-30.
9. U.S. Food and Drug Administration. Determination That REVIA (Naltrexone Hydrochloride) Tablets, 50 Milligrams Was Not Withdrawn From Sale for Reasons of Safety or Effectiveness. Federal Register document 2026-07451, published April 16, 2026. https://www.federalregister.gov/d/2026-07451 Accessed 2026-09-30.
10. Parkitny L, Younger J. Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. 2017. DOI: 10.3390/biomedicines5020016. https://pmc.ncbi.nlm.nih.gov/articles/PMC5489802/ Accessed 2026-09-30.
11. Hutchinson MR et al. Non-stereoselective reversal of neuropathic pain by naloxone and naltrexone: involvement of toll-like receptor 4 (TLR4). 2008. DOI: 10.1111/j.1460-9568.2008.06321.x. https://pmc.ncbi.nlm.nih.gov/articles/PMC2588470/ Accessed 2026-09-30.
12. Gironi M et al. A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis. 2008. DOI: 10.1177/1352458508095828. https://pubmed.ncbi.nlm.nih.gov/18728058/ Accessed 2026-09-30.
13. Metz MJ, Daimon CM, Hentges ST. Reported Benefits of Low-Dose Naltrexone Appear to Be Independent of the Endogenous Opioid System Involving Proopiomelanocortin Neurons and β-Endorphin. 2021. DOI: 10.1523/ENEURO.0087-21.2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8211470/ Accessed 2026-09-30.
14. Anton RF, O’Malley SS, Ciraulo DA, et al. Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A Randomized Controlled Trial. 2006. DOI: 10.1001/jama.295.17.2003. https://jamanetwork.com/journals/jama/fullarticle/202789 Accessed 2026-09-30.
15. Garbutt JC, Kranzler HR, O’Malley SS, et al. Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial. 2005. DOI: 10.1001/jama.293.13.1617. https://jamanetwork.com/journals/jama/fullarticle/200637 Accessed 2026-09-30.
16. Substance Abuse and Mental Health Services Administration. TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice, Chapter 4: Oral Naltrexone. 2009. https://www.ncbi.nlm.nih.gov/sites/books/NBK64042/ Accessed 2026-09-30.
17. Santos GM, Ikeda J, Coffin P, et al. Targeted Oral Naltrexone for Mild to Moderate Alcohol Use Disorder Among Sexual and Gender Minority Men: A Randomized Trial. 2022. DOI: 10.1176/appi.ajp.20220335. https://psychiatryonline.org/doi/full/10.1176/appi.ajp.20220335 Accessed 2026-09-30.
18. Magane KM, Dukes KA, Fielman S, et al. Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use Disorder: A Randomized Clinical Trial. 2025. DOI: 10.1001/jamainternmed.2025.0522. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832702 Accessed 2026-09-30.
19. Shulman M, Greiner MG, Tafessu HM, et al. Rapid Initiation of Injection Naltrexone for Opioid Use Disorder: A Stepped-Wedge Cluster Randomized Clinical Trial. 2024. DOI: 10.1001/jamanetworkopen.2024.9744. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818410 Accessed 2026-09-30.
20. Lee JD, Nunes EV Jr, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. 2018. DOI: 10.1016/S0140-6736(17)32812-X. https://pmc.ncbi.nlm.nih.gov/articles/PMC5806119/ Accessed 2026-09-30.
21. Larochelle MR, Bernson D, Land T, et al. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. 2018. DOI: 10.7326/M17-3107. https://stacks.cdc.gov/view/cdc/101059/cdc_101059_DS1.pdf Accessed 2026-09-30.
22. Hsu HE, Lodi S, Yan S, et al. Buprenorphine-Naloxone vs Extended-Release Naltrexone Following Opioid Withdrawal Treatment. 2026. DOI: 10.1001/jamanetworkopen.2026.23280. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2851609 Accessed 2026-09-30.
23. Ross RK, Nunes EV, Olfson M, Shulman M, Krawczyk N, Stuart EA, Rudolph KE. Comparative effectiveness of extended-release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients. 2024. DOI: 10.1111/add.16630. https://onlinelibrary.wiley.com/doi/10.1111/add.16630 Accessed 2026-09-30.
24. Alkermes, Inc. VIVITROL Medication Guide. Revised December 2025; DailyMed label version May 31, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cd11c435-b0f0-4bb9-ae78-60f101f3703f Accessed 2026-09-30.
25. Greenway FL et al.; COR-I Study Group. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. 2010. DOI: 10.1016/S0140-6736(10)60888-4. https://pubmed.ncbi.nlm.nih.gov/20673995/ Accessed 2026-09-30.
26. Trivedi MH et al. Bupropion and Naltrexone in Methamphetamine Use Disorder. 2021. DOI: 10.1056/NEJMoa2020214. https://pmc.ncbi.nlm.nih.gov/articles/PMC8111570/ Accessed 2026-09-30.
27. Clinical Guideline Committee (CGC) Members; ASAM Team; AAAP Team; IRETA Team. The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. 2024. DOI: 10.1097/ADM.0000000000001299. https://pmc.ncbi.nlm.nih.gov/articles/PMC11105801/ Accessed 2026-09-30.
28. Grant JE, Kim SW, Hartman BK. A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of pathological gambling urges. 2008. DOI: 10.4088/JCP.v69n0511. https://pubmed.ncbi.nlm.nih.gov/18384246/ Accessed 2026-09-30.
29. Kovanen L et al. A Randomised, Double-Blind, Placebo-Controlled Trial of As-Needed Naltrexone in the Treatment of Pathological Gambling. 2016. DOI: 10.1159/000435876. https://pubmed.ncbi.nlm.nih.gov/26339899/ Accessed 2026-09-30.
30. Grilo CM et al. Naltrexone/bupropion for binge-eating disorder: A randomized, double-blind, placebo-controlled trial. 2023. DOI: 10.1002/oby.23898. https://pmc.ncbi.nlm.nih.gov/articles/PMC10600891/ Accessed 2026-09-30.
31. Wolfhagen FHJ et al. Oral Naltrexone Treatment for Cholestatic Pruritus: A Double-Blind, Placebo-Controlled Study. 1997. DOI: 10.1053/gast.1997.v113.pm9322521. https://repub.eur.nl/pub/55221/1-s2.0-S0016508597004782-main.pdf Accessed 2026-09-30.
32. Pauli-Magnus C et al. Naltrexone does not relieve uremic pruritus: results of a randomized, double-blind, placebo-controlled crossover study. 2000. DOI: 10.1681/ASN.V113514. https://pubmed.ncbi.nlm.nih.gov/10703675/ Accessed 2026-09-30.
33. Rodríguez-Freire C et al. Efficacy of Low-Dose Naltrexone in Women With Fibromyalgia Syndrome: A 12-Month Randomised, Double-Blind, Placebo-Controlled Single-Centre Clinical Trial (INNOVA Study). 2026. DOI: 10.1002/ejp.70321. https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.70321 Accessed 2026-09-30.
34. van de Pol N et al. Low-Dose Naltrexone in Crohn’s Disease: A Prematurely Terminated Randomized Trial Showing Reduced Fatigue Without Clinical or Endoscopic Benefit. 2026. DOI: 10.1007/s10620-026-10234-y. https://link.springer.com/article/10.1007/s10620-026-10234-y Accessed 2026-09-30.
35. Sharafaddinzadeh N et al. The effect of low-dose naltrexone on quality of life of patients with multiple sclerosis: a randomized placebo-controlled trial. 2010. DOI: 10.1177/1352458510366857. https://journals.sagepub.com/doi/10.1177/1352458510366857 Accessed 2026-09-30.
36. O’Kelly B et al. Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study. 2022. DOI: 10.1016/j.bbih.2022.100485. https://pmc.ncbi.nlm.nih.gov/articles/PMC9250701/ Accessed 2026-09-30.
37. Polo O, Pesonen P, Tuominen E. Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 2019. DOI: 10.1080/21641846.2019.1692770. https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770 Accessed 2026-09-30.
38. National Institute for Health and Care Excellence. Gambling-related harms: identification, assessment and management (NG248), recommendations 1.5.16-1.5.19. January 2025. https://www.nice.org.uk/guidance/ng248/chapter/recommendations Accessed 2026-09-30.
39. Grant JE, Kim SW, Odlaug BL. A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania. 2009. DOI: 10.1016/j.biopsych.2008.11.022. https://pubmed.ncbi.nlm.nih.gov/19217077/ Accessed 2026-09-30.
40. Lew-Starowicz M et al. Tolerability and efficacy of paroxetine and naltrexone for treatment of compulsive sexual behaviour disorder. 2022. DOI: 10.1002/wps.21026. https://onlinelibrary.wiley.com/doi/full/10.1002/wps.21026 Accessed 2026-09-30.
41. Grant JE, Odlaug BL, Schreiber LRN, Kim SW. The opiate antagonist, naltrexone, in the treatment of trichotillomania: results of a double-blind, placebo-controlled study. 2014. DOI: 10.1097/JCP.0000000000000037. https://pubmed.ncbi.nlm.nih.gov/24145220/ Accessed 2026-09-30.
42. Willemsen-Swinkels SHN, Buitelaar JK, Nijhof GJ, van Engeland H. Failure of Naltrexone Hydrochloride to Reduce Self-Injurious and Autistic Behavior in Mentally Retarded Adults: Double-blind Placebo-Controlled Studies. 1995. DOI: 10.1001/archpsyc.1995.03950210060011. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/497215 Accessed 2026-09-30.
43. Albers LN, Arbiser JL, Feldman RJ. Treatment of Hailey-Hailey Disease With Low-Dose Naltrexone. 2017. DOI: 10.1001/jamadermatol.2017.2446. https://jamanetwork.com/journals/jamadermatology/article-abstract/2646786 Accessed 2026-09-30.
44. Lajevardi V et al. The efficacy and safety of oral low dose naltrexone versus placebo in the patients with lichen planopilaris: a randomized controlled clinical trial. 2022. DOI: 10.1080/09546634.2020.1774488. https://pubmed.ncbi.nlm.nih.gov/32449418/ Accessed 2026-09-30.
45. US Food and Drug Administration. Understanding the Risks of Compounded Drugs. Current live resource. https://www.fda.gov/drugs/human-drug-compounding/understanding-risks-compounded-drugs Accessed 2026-09-30.
46. Younger J, Noor N, McCue R, Mackey S. Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. 2013. DOI: 10.1002/art.37734. https://pubmed.ncbi.nlm.nih.gov/23359310/ Accessed 2026-09-30.
47. Bested K et al. Low-dose naltrexone for treatment of pain in patients with fibromyalgia: a randomized, double-blind, placebo-controlled, crossover study. 2023. DOI: 10.1097/PR9.0000000000001080. https://pmc.ncbi.nlm.nih.gov/articles/PMC10789452/ Accessed 2026-09-30.
48. Due Bruun K et al. Low-dose naltrexone for fibromyalgia: a re-analysis suggests lower efficacy than previously reported. 2026. DOI: 10.3344/kjp.25275. https://pmc.ncbi.nlm.nih.gov/articles/PMC12765631/ Accessed 2026-09-30.
49. Beaudette-Zlatanova B et al. Pilot Study of Low-dose Naltrexone for the Treatment of Chronic Pain Due to Arthritis: A Randomized, Double-blind, Placebo-controlled, Crossover Clinical Trial. 2023. DOI: 10.1016/j.clinthera.2023.03.013. https://pubmed.ncbi.nlm.nih.gov/37045708/ Accessed 2026-09-30.
50. Srinivasan A et al. Efficacy and safety of low-dose naltrexone in painful diabetic neuropathy: A randomized, double-blind, active-control, crossover clinical trial. 2021. DOI: 10.1111/1753-0407.13202. https://pubmed.ncbi.nlm.nih.gov/34014028/ Accessed 2026-09-30.
51. Smith JP et al. Therapy with the Opioid Antagonist Naltrexone Promotes Mucosal Healing in Active Crohn’s Disease: A Randomized Placebo-Controlled Trial. 2011. DOI: 10.1007/s10620-011-1653-7. https://pmc.ncbi.nlm.nih.gov/articles/PMC3381945/ Accessed 2026-09-30.
52. Cree BAC et al. Pilot trial of low-dose naltrexone and quality of life in multiple sclerosis. 2010. DOI: 10.1002/ana.22006. https://pubmed.ncbi.nlm.nih.gov/20695007/ Accessed 2026-09-30.
53. University of British Columbia / Nacul L et al. Low Dose Naltrexone for Post-COVID Fatigue Syndrome (NCT05430152). 2026. https://clinicaltrials.gov/study/NCT05430152 Accessed 2026-09-30.
54. ME Association. Treatment: Clinical trials into the use of LDN in ME/CFS, Long Covid and Fibromyalgia. 2026. https://meassociation.org.uk/2026/08/treatment-clinical-trials-into-the-use-of-ldn-in-me-cfs-long-covid-and-fibromyalgia/ Accessed 2026-09-30.
55. Peters KB et al. Effects of low-dose naltrexone on quality of life in high-grade glioma patients: a placebo-controlled, double-blind randomized trial. 2022. DOI: 10.1007/s00520-021-06738-0. https://pubmed.ncbi.nlm.nih.gov/35001215/ Accessed 2026-09-30.
56. Willemsen-Swinkels SH, Buitelaar JK, van Engeland H. The effects of chronic naltrexone treatment in young autistic children: a double-blind placebo-controlled crossover study. 1996. DOI: 10.1016/0006-3223(95)00297-9. https://pubmed.ncbi.nlm.nih.gov/8780837/ Accessed 2026-09-30.
57. Courtney Jarka and Kelsey Gregoire. Precipitated withdrawal with kratom use following naltrexone administration. 2023. DOI: 10.9740/mhc.2023.06.155. https://pubmed.ncbi.nlm.nih.gov/37448827/ Accessed 2026-09-30.
58. Rachel Thompson, Tamar Taddei, David Kaplan, and Anahita Rabiee. Safety of naltrexone in patients with cirrhosis. 2024. DOI: 10.1016/j.jhepr.2024.101095. https://pubmed.ncbi.nlm.nih.gov/38961852/ Accessed 2026-09-30.
59. Alla M, Varshney M, Bhardwaj A, Kumar G, Shasthry SM, Sarin SK. Naltrexone Is Superior to Placebo for Abstinence and Craving Reduction in Alcohol-Associated Cirrhosis: NAL-CI Trial. 2026. DOI: 10.1111/liv.70845. https://onlinelibrary.wiley.com/doi/full/10.1111/liv.70845 Accessed 2026-09-30.
60. American College of Obstetricians and Gynecologists and American Society of Addiction Medicine. Opioid Use and Opioid Use Disorder in Pregnancy. 2017. Revision August 2017. https://www.asam.org/quality-care/clinical-recommendations/OUD-in-Pregnancy Accessed 2026-09-30.
61. National Institute of Child Health and Human Development, Drugs and Lactation Database (LactMed). Naltrexone. 2026. Revision February 15, 2026. https://www.ncbi.nlm.nih.gov/sites/books/NBK501239/?report=reader Accessed 2026-09-30.
62. Academy of Breastfeeding Medicine. Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). 2023. https://www.breastfeedingmedicine.com/assets/DOCUMENTS/PROTOCOLS/ABM%20Clinical%20Protocol%2021%20SUD_English.pdf Accessed 2026-09-30.
63. American Society of Health-System Pharmacists; hosted by NIH/NLM MedlinePlus. Naltrexone Injection: MedlinePlus Drug Information. 2026. Revision September 15, 2026. https://www.medlineplus.gov/druginfo/meds/a609007.html Accessed 2026-09-30.
64. 988 Suicide & Crisis Lifeline; Vibrant Emotional Health. 988 Lifeline. Undated. https://988lifeline.org/ Accessed 2026-09-30.
65. American Society of Addiction Medicine. National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update, Provider Guide. 2020. https://eguideline.guidelinecentral.com/i/1224390-national-practice-guideline-for-the-treatment-of-opioid-use-disorder-2020-update/24 Accessed 2026-09-30.
66. Moloney BD et al. Low-dose naltrexone as an adjunctive treatment for major depressive disorder: findings from a randomized, double-blind, placebo-controlled hybrid parallel-arm study. 2026. DOI: 10.3389/fphar.2026.1767654. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2026.1767654/full Accessed 2026-09-30.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, or chat at 988lifeline.org, available 24/7, free and confidential. En español: marque 988 y oprima 2, o envíe AYUDA al 988. Deaf or hard of hearing: 988 videophone (ASL) or TTY 711 then 988. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.