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Naltrexone, sold under the brand names ReVia and Vivitrol among others, is a medication primarily used to manage alcohol or opioid dependence. An opioid-dependent person should not receive naltrexone before detoxification. Effects begin within 30 minutes. A decreased desire for opioids, though, may take a few weeks. Side effects may include trouble sleeping, anxiety, nausea, and headaches. In those still on opioids, opioid withdrawal may occur. Use is not recommended in people with liver failure. It is unclear if use is safe during pregnancy. Naltrexone is an opioid antagonist and works by blocking the effects of opioids, both those from inside and outside the body. Naltrexone was first made in 1965 and was approved for medical use in the United States in 1984. Naltrexone has been best studied as a treatment for alcoholism. Naltrexone has been shown to decrease the amount and frequency of drinking. It does not appear to change the percentage of people drinking. Its overall benefit has been described as "modest". The Sinclair method is a method of using opiate antagonists such as naltrexone to treat alcoholism. The person takes the medication about an hour (and only then) before drinking to avoid side effects that arise from chronic use. The opioid antagonist blocks the positive-reinforcement effects of alcohol and allows the person to stop or reduce drinking. Long-acting injectable naltrexone decreases heroin use more than placebo. It has benefits over methadone and buprenorphine in that it is not a restricted medication. It may decrease cravings for opioids after a number of weeks, and decreases the risk of overdose. It is given once per month and has better compliance than the oral formulation. While some do well with this formulation, it must be taken daily, and a person whose cravings become overwhelming can obtain opioid intoxication simply by skipping a dose. Due to this issue, the usefulness of oral naltrexone in opioid use disorders is limited by the low retention in treatment. Naltrexone by mouth remains an ideal treatment for a small number of people with opioid use, usually those with a stable social situation and motivation.




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