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Naltrexone is an alcohol withdrawal medication that helps reduce cravings and maintain recovery. It does not treat acute withdrawal symptoms. However, it plays an important role in long term relapse prevention.
In this article, you’ll learn how naltrexone works in the brain, when it is prescribed and what benefits it offers during alcohol use disorder treatment. We’ll also cover how it differs from other alcohol withdrawal medications and what to expect if you or a loved one begins treatment with naltrexone.
Key Facts
- Alcohol withdrawal happens within hours after stopping heavy use, peaking at 24–72 hours and resolving in about a week.
- Naltrexone does not address acute withdrawal but supports recovery after detox.
- This medication blocks opioid receptors to reduce cravings and relapse risk.
- Safe use requires being opioid free, having stable liver function and completing detox.
- Oral (daily pill) and injectable (monthly shot) forms allow flexible treatment planning.
- Benzodiazepines and phenobarbital, not naltrexone, treat the acute withdrawal phase.
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The Role Naltrexone Plays in Alcohol Withdrawal
Naltrexone plays an important role in alcohol use disorder treatment, but not in the way you may assume. The main purpose is to support long term recovery by lowering cravings and reducing the risk of relapse.
Alcohol Withdrawal 101
Alcohol withdrawal happens when your body reacts to the sudden absence of alcohol after heavy or prolonged use. Symptoms of withdrawal usually begin within 6 to 24 hours, peaking around 24 to 72 hours and resolving within 3 to 7 days.
Symptoms may range from mild anxiety and tremors to more severe complications like seizures or delirium tremens (DTs).
Certain warning signs require urgent medical attention. These red flags include confusion, hallucinations, high fever, uncontrolled vomiting and severe tremors. If any of these occur, immediate medical care is critical for your safety.
Why Naltrexone Isn’t for Acute Withdrawal & Where It Fits After Detox
Naltrexone does not manage the immediate dangers of alcohol withdrawal. These include autonomic hyperactivity, seizures or other acute symptoms. These are commonly treated with medications like benzodiazepines or phenobarbital under medical supervision.
Using naltrexone in the early stage of alcohol withdrawal does not provide the necessary protection against serious risks. However, naltrexone plays a crucial role after detox, when the focus shifts from short term stabilization to long term recovery.
Naltrexone helps reduce cravings, lowers the number of heavy drinking days and supports ongoing sobriety. This makes it a valuable tool in relapse prevention and sustained recovery in alcohol use disorder treatment.
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How Naltrexone Works and When to Start
Naltrexone is an important medication, but timing is key to its effectiveness. It should be introduced after detox, once your body is clear of alcohol and withdrawal symptoms have resolved.
Mechanism & Expected Benefits
Naltrexone works as a mu opioid receptor antagonist. They block your brain’s reward pathways that are normally activated by alcohol. By reducing the pleasurable effects of drinking, it helps weaken the urge to drink in response to triggers or environmental cues.
The benefits of this approach include fewer heavy drinking days, longer periods before relapse and improved outcomes when combined with counseling or structured therapy. Together, these effects make naltrexone a valuable tool in your long term recovery.
When to Start Naltrexone After Detox and Pre-Start Checklist
Beginning naltrexone too early can be unsafe and may interfere with proper recovery from the acute withdrawal phase.
Several criteria must be considered before beginning naltrexone, including:
- Alcohol withdrawal symptoms are fully resolved
- Confirmed opioid free to avoid severe withdrawal
- Thorough review of current medications and allergies
- Baseline liver function tests
- Comprehensive education to ensure safe and effective use
Options, Dosing and Choosing the Right Formulation
Naltrexone is available in oral and injectable forms. This allows you and your providers flexibility in customizing your treatment plan.
The appropriate option depends on factors like lifestyle, adherence and medical history. This highlights the need to consider common dosing approaches and key considerations to select the most effective formulation.
Oral Naltrexone (Typically 50 mg Daily)
Oral naltrexone is most often prescribed at 50 mg per day. However, administration can begin with a 25 mg test dose before titrating up. Taking naltrexone with food can help reduce gastrointestinal discomfort.
This option is well suited as a first line trial since it is easy to start, stop or adjust the dosage as needed. However, it is critical that you consistently adhere to treatment since missed doses can limit the effectiveness and reduce the medication’s ability to curb cravings.
Extended Release Naltrexone (380 mg IM Monthly)
Extended release naltrexone is given as a 380 mg intramuscular injection once a month. This is a convenient alternative when you struggle with daily pill taking or prefer a long acting option. This formulation helps ensure steady medication levels and consistent support against cravings.
Before beginning treatment, your provider takes several precautions to reduce complications and make treatment more effective. These steps include:
- Screening for potential injection site concerns
- Confirming you are opioid free for an adequate period
- Reviewing full medical history
- Checking baseline liver function
- Education on what to expect during treatment
Choosing Oral vs. Injection
Deciding between oral and injectable naltrexone depends on several factors. These include adherence, access to care, insurance coverage, side effect tolerance and personal preference. The best choice varies by individual needs.
It’s important to consider logistics such as the ability to attend monthly clinic visits for injections. As well you should have plans for managing missed doses and whether transitioning between formulations might be helpful over time. A collaborative discussion with a provider ensures the most practical and effective approach.
Safety and Special Situations
Naltrexone is generally safe and well tolerated. However, certain health conditions and circumstances require extra caution. This section outlines key safety considerations and special situations where careful monitoring or alternative approaches may be needed.
Liver Safety & Monitoring
Naltrexone should not be used if you have acute hepatitis or liver failure. Baseline liver function tests (LFTs) are recommended before starting treatment. Periodic monitoring helps ensure continued safety during use.
Providers carefully weigh the risks and benefits when you have mild to moderate enzyme elevations. They educate you about the warning signs of hepatitis, such as jaundice, dark urine or abdominal pain. This proactive approach supports both safety and effective treatment.
Opioid Free Status & Pain Management Planning
Before starting naltrexone, individuals must be completely opioid free to avoid precipitated withdrawal. Once on treatment, the medication blocks opioid receptors, making opioid based pain relief ineffective.
For surgeries or procedures, advanced planning is essential. Non opioid pain management strategies should be prioritized. If opioids are absolutely required, coordination with specialists helps ensure safe and effective care.
What Treats Alcohol Withdrawal
Alcohol withdrawal requires medications that directly calm the nervous system and prevent dangerous complications as the body detoxifies. These are first line medications that work differently from naltrexone, but are critical to recovery.
First Line Medications & When Inpatient Care Is Needed
The mainstay of alcohol withdrawal treatment is benzodiazepines, given either on a symptom triggered schedule or as fixed doses. A customized treatment plan based on evidence based measurement tools helps providers make accurate decisions about how medications are administered.
In some experienced settings, phenobarbital may be added for additional control. Supportive care is equally important. This includes thiamine before glucose, fluids and electrolytes and close monitoring of vital signs.
Inpatient care becomes necessary when there is a high risk of severe alcohol withdrawal symptoms.
Admission is recommended when there is a history of:
- Severe withdrawal
- Seizures
- Delirium tremens
- Unstable vital signs
- Pregnancy
- Limited support at home
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Naltrexone Frequently Asked Questions
No, naltrexone does not manage tremors, agitation, blood pressure spikes or seizures.
These symptoms require evidence based withdrawal protocols, often with benzodiazepines or phenobarbital. Naltrexone is introduced after detox and stabilization to support long term recovery and reduce cravings.
Naltrexone is usually started once acute withdrawal symptoms are resolved. This commonly occurs between 3 to 7 days of abstinence.
Before beginning, your provider confirms you are opioid free and have acceptable liver function tests. Follow up visits help monitor your response and ensure the medication is well tolerated.
Always inform your care team that you’re taking naltrexone. For elective procedures, planning is essential.
Non opioid pain control is preferred. However, if opioids are necessary, they must be managed carefully by specialists. Naltrexone can be safely restarted once opioids are no longer required.
Find Treatment Near You
Finding the right treatment program for alcohol withdrawal is crucial to your long term success. Naltrexone plays a unique role in supporting sustainable recovery.
Use the treatment directory at Rehab.com to search for centers that match your needs. You can filter by location, level of care, accepted insurance and special programs to find the right fit.
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Top Rated Centers for Alcohol Addiction Treatment
| Name / Address / Rating | Description | Treatments / Payments / Programs | Review / Contact | Images | |
|---|---|---|---|---|---|
Boca Recovery Center – Bloomington Alcohol & Drug RehabAd This is an ad and Boca Recovery Center – Bloomington Alcohol & Drug Rehab is a paid advertiser. Paid advertisers may be listed first in search results. This ad may contain content provided by the advertiser. Rehab.com does not verify ad content or any reviews that are displayed. Learn More 2
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| The Boca Recovery Center is a luxury alcohol and drug rehab center for adults in Bloomington, Indiana. They specialize in cutting edge addiction treatment provided in a residential setting. One unique part of this alcohol and drug rehab in Indiana is the peaceful, secluded setting. If recovering in a clinical hospital setting doesn’t sound very a | Treatments Programs Payment Options  Drug Addiction Alcoholism Opioid Addiction Dual Diagnosis Mental Health and Substance Abuse Substance Abuse  Adult Program Young Adult Program Seniors Program LGBTQ Program Military Program  Private Insurance Self-Pay Options Military Insurance Financial Aid | View Website (930) 203-1400 | 
Its a great place
Andrea Youngblood
3 weeks ago
I had a wonderful experience at Boca recovery center they helped me with a lot of things, they gave me a lot of tools and resources that I currently continuing to work with.They have helped me in my recovery journey as I continue to be mindful of my triggers to prevent relapse. To all that are reading this may God of the universe continue to guide you on your recovery journey as well Amen! ☺️🙏
Diamond Louis
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Staff was amazing. Very comforting and friendly. Made me feel at home while going through a difficult time. Thank you Boca Recovery Center
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Excellent staff and service. Very comfortable experience. Highly recommend. The support here is amazing.
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Symetria is unbelievably amazing!!! The Hurst staff is phenomenal!!! I can’t imagine that another location has a better staff. A special shout out to Deborah, Benjamin, and Samantha of course. You all are doing amazing, amazing, selfless work. You all are very special to so many!!!
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BEST PLACE EVER. I have tried various other doctors/clinics and none of them even begin to compare to this one. The staff here is absolutely amazing. I can’t even make a single complaint. Dr Son is the best as well. He explains everything and you truly feel like he understands you. I can proudly say this, this place saved my life. If you or someone you know needs help getting off opiates do it right the first time and come here. You won’t be disappointed. If you are specifically struggling with fentanyl please don’t waste your time with other ways. I have tried 6 other methods from lazer therapy to having the earpiece to suboxone. Methadone is the key to our current fentanyl crisis. This clinic makes recovery possible again!
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Avenues Recovery Center at ClarksvilleAd This is an ad and Avenues Recovery Center at Clarksville is a paid advertiser. Paid advertisers may be listed first in search results. This ad may contain content provided by the advertiser. Rehab.com does not verify ad content or any reviews that are displayed. Learn More 1
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Claimed | Avenues Recovery Center in Clarksville, Indiana, is an inpatient drug and alcohol detox and rehab center. They strive to provide individuals receiving treatment with a loving environment and attentive medical care. You’ll be away from toxic environments and triggers and have the opportunity to focus on developing life skills that will support you | Treatments Programs Payment Options AlcoholismMental Health And Substance AbuseDrug AddictionOpioid AddictionSubstance AbuseDual DiagnosisMental Health Adult ProgramYoung Adult ProgramLGBTQ ProgramMilitary Program Private InsuranceSelf-Pay OptionsMedicaidMilitary Insurance | View Website (930) 203-1947 | 
This place is amazing, they will show you how to redirect you life for the better. Don’t knock it until you have tried it
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Avenues is beyond amazing!!💗🙌🏼 The support, both staff & clients is amazing. The curriculum is so life changing centered around your addiction as well as mental, emotional & physical health. I finally understand it all which really helps finally knowing what to do!!
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Avenues Recovery center is a very good place love the staff love the facilitators love the case managers there’s a lot of good help here
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Claimed | All In Solutions Counseling Center is a mental health center and addiction treatment program in Boynton Beach, Florida. They provide a partial hospitalization program, an intensive outpatient program (IOP), an outpatient program, medication-assisted treatment, and mental health care for adults with substance use disorder. All In Solutions Counseli | Treatments Programs Payment Options AlcoholismDrug AddictionOpioid AddictionSubstance AbuseDual DiagnosisMental Health And Substance Abuse Adult ProgramYoung Adult ProgramProgram For MenProgram For Women Self-Pay OptionsPrivate insurance | 
All in was a great program! The staff was amazing. Very helpful in my recovery! They were very attentive.
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This place helped me when I felt like no one could, 5 stars to the techs, 5 to the therapists, and 5 to case management will love you guys for ever.
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My experience at All in Solutions was absolutely the best it could be given the situation. The staff were absolutely amazing. With this course of recovery I’ve been given the keys for a bright future. It’s up to me to put my training to work in in my life.
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Claimed | Boca Recovery Center – Galloway is a drug and alcohol rehab in Galloway, NJ. They provide inpatient addiction treatment and medical detox. Boca Recovery’s New Jersey Drug & Alcohol Rehab, located in Galloway, New Jersey offers residential addiction treatment, medical detox, and medication-assisted treatment in an immersive treatment s | Treatments Programs Payment Options Mental Health and Substance AbuseDrug AddictionAlcoholismOpioid AddictionDual DiagnosisSubstance Abuse Adult ProgramYoung Adult ProgramProgram For MenProgram For WomenSeniors ProgramLGBTQ ProgramMilitary Program Private InsuranceSelf-Pay OptionsMilitary InsuranceFinancial Aid | 
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Coming from Canada, I was hesitant. But God knew that S2L was exactly where I needed to be. At 64 years of age, I was able to discover my true identity, purpose, and mission in Christ. They help you in trying to get clean and sober for sure. But what S2L and the staff are all about is the Gospel of Jesus Christ. That’s why it is so successful.
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I’ve had the privilege of seeing the life-changing impact this ministry has on countless men & I can’t recommend it highly enough! God has His Hand on this ministry & I’m honored to see the Lord work in these men!
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| The Steps To Recovery addiction treatment center is situated in Levittown, Pennsylvania. At this drug rehab center, patients can expect to engage in a unique treatment approach that focuses on helping individuals recover through authenticity, intimacy, community connection, and transparency. Steps to Recovery offers a serene and private environ | Treatments Programs Payment Options AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionMental Health Adult ProgramLGBTQ ProgramYoung Adult ProgramMilitary Program Self-Pay Options MonthlyPrivate Insurance | 
Good place, great housing
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Claimed | Located in Watsonville, California, Elevate Addiction Services provides alcohol and drug rehab services to men and women suffering from addiction. Their levels of care include detox, inpatient treatment, and outpatient treatment. One of the best ranked Outpatient treatment centers in California, Elevate Addiction Services provides a wide continuum | Treatments Programs Payment Options AlcoholismDrug AddictionOpioid AddictionSubstance Abuse Adult ProgramYoung Adult ProgramLGBTQ Program Self-Pay OptionsPrivate insuranceMilitary InsurancePrivate Insurance Financing | 
Our experience with Elevate Addiction Services has been truly life-changing. From the very beginning, the director, family liaisons, counselors, therapists, continuing care coordinators, house dad’s – we felt genuine compassion and care from everyone we had the pleasure of interacting with. We were kept informed of how our son was doing every step of the way. It never felt like we were alone in this. Everyone at Elevate was fighting for our son right alongside of us.
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