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There are very few naltrexone contraindications when taken at the dose used for alcohol treatment, but it’s still important to work with a qualified clinician before taking the medication.
What You’ll Learn:
- Why contraindications mostly revolve around opioid use disorder treatment.
- The true naltrexone contraindications and avoidable contraindications for alcohol use treatment:
- Naltrexone allergies that are very rare.
- Concerns for people with liver failure.
- Livery injury concerns in people with acute hepatitis.
- Pregnancy is a “use with caution” scenario rather than a contraindication.
- How dosage factors into contraindications.
Naltrexone is a very safe prescription medication that has been used to effectively treat opioid use disorder for decades as well as helping people curb alcohol cravings and consumption. But that doesn’t mean people should start taking it without first consulting with a qualified clinician.
While rare, there are several contraindications associated with naltrexone use. A contraindication is a medical condition that makes a specific medication or treatment inadvisable due to risk factors. However, with naltrexone there are a few true contraindications and a few avoidable ones, which means taking naltrexone to curb alcohol cravings may still be possible.
Why Many Naltrexone Contraindications Are Related to Opioid Use
Research has shown that a number of naltrexone contraindications are associated with opioid treatment, not naltrexone alcohol treatment. People who are dependent on opioids, currently using them or within the withdrawal stage can go into severe withdrawal while taking naltrexone.
The recommendation is to start naltrexone treatment after 7-14 days of abstaining from opioids so that the person is through the detox period.
Taking opioid analgesia medications for pain management is another contraindication. This is because the naltrexone will prevent the medication from having an effect and pain can’t be managed. If opioid analgesia use is short-term for a surgery or injury, naltrexone use needs to be planned accordingly.
Naltrexone Contraindications Related to Alcohol Use Treatment
Fortunately, there are very few true naltrexone contraindications for people who want to control their alcohol consumption, and some are standard for any type of medication. There are also conditions that are considered avoidable contraindications, which means naltrexone could still potentially be used.
Allergies to Naltrexone Components
Just as with any medication, if a person is allergic to naltrexone they are advised to not take it. The upside is that naltrexone is a pure medication. There are no other additives in naltrexone tablets.
Allergic reactions to naltrexone are extremely rare. When an allergic reaction does occur it’s usually mild and not life-threatening. The typical side effects are itching, rash and face/throat swelling.
Liver Failure
Naltrexone is cleared by the liver and could be hepatotoxic in higher doses, which means it has the potential to damage liver cells and compromise liver function. Since there is a risk of liver failure, anyone who has a failing liver isn’t a candidate for naltrexone.
If someone has liver disease it isn’t automatically considered a contraindication. If the liver disease is under control and stable, taking naltrexone is possible with monitoring from a medical professional. The person will first need to have a baseline liver function test to determine if the naltrexone benefits outweigh the risk. When the benefits outweigh the risk the person is put on the lowest effective dose to avoid complications.
Acute Hepatitis
People with acute hepatitis shouldn’t take naltrexone for the same reasons as those with liver disease or liver failure. The risk of hepatotoxicity can complicate matters and cause poor outcomes.
If a person has hepatitis B or hepatitis C that is stabilized, naltrexone is still an option so long as use is monitored by a clinician. Baseline and regular liver function tests are also highly advisable in these situations.
Kidney Disease
Unless a person is experiencing renal failure, naltrexone can be used by someone with kidney disease. In these scenarios the clinician will be conservative with the dosing, provide constant monitoring and use baseline renal kidney function tests to make sure there isn’t a serious risk.
Pregnancy
Pregnancy is another medical condition that warrants caution when prescribing naltrexone. There are no known medical problems, but very little data on naltrexone’s effect during pregnancy exists. Doctors have to take extreme caution so they will only prescribe naltrexone if the risk of drinking alcohol during pregnancy is significant and there are no other viable options.
Contraindications and Naltrexone Dose Levels
As noted a few times already, the dosage is a factor for naltrexone contraindications. The oral form of the medication appears to be very safe. At standard doses of naltrexone 50 mg tablets very rarely harms the liver. Hepatotoxicity is generally only associated with high doses of naltrexone.
If someone with an avoidable contraindication can benefit from using naltrexone, they are prescribed the lowest dose possible and carefully monitored.
Bottomline: Oral Naltrexone Has Very Few Contraindications, Especially at Standard Doses For Alcohol Treatment
- Only several contraindications exist when using oral naltrexone for controlling alcohol use.
- People with stable liver disease, kidney disease, hepatitis B and hepatitis C can still use naltrexone under the supervision of medical professionals.
- Naltrexone dosage is a factor for people with contraindications.
- Function tests can help people with contraindications know if naltrexone is safe to continue using.
At Choose Your Horizon our primary focus is helping people be their healthiest. Our telehealth platform allows patients to get a convenient online naltrexone prescription that is monitored by a qualified clinician who can adjust the dose as needed.
Take the Alcohol Use Assessment to learn more about using naltrexone to curb alcohol cravings and get your drinking under control.
