Considerations before taking
Safety and toxicity. Naltrexone does not cause dependence or intoxication, but taking higher doses than prescribed can be toxic to the liver.
Risk of opioid overdose. People who resume using opioids during or after naltrexone treatment may have an elevated risk of overdose, especially if they use large amounts of opioids to overcome the naltrexone’s blocking effects. Naltrexone can also decrease tolerance for opioids and make people more sensitive to their effects. This sensitivity can heighten the risk of overdose in someone who stops taking naltrexone and then takes a “regular” dose of opioids.
Once injected, extended-release naltrexone remains in the body for approximately 28 days. It will block the effects of opioids for about that length of time.
Pregnancy and breastfeeding. Initiating naltrexone for OUD requires going through the opioid withdrawal process, which may be dangerous in pregnancy for both the pregnant person and the fetus. However, a pregnant person who is already taking naltrexone, or who would like to start naltrexone for AUD and who is not using opioids, may be able to safely take naltrexone during pregnancy. If you are planning a pregnancy, are pregnant, or are breastfeeding, talk with your medical provider about whether you can safely take naltrexone. Little naltrexone is excreted into breast milk, so breastfeeding while taking naltrexone is generally considered safe.
Interactions. Before taking naltrexone, make sure your system is free of opioids. In addition to being free of opioids, you should not drink alcohol, take sedatives, or use certain other types of drugs while taking naltrexone. Talk to your medical provider or pharmacist about possible interactions with any other drugs you’re taking, including over-the-counter medicines, vitamins, and supplements.
Cost. A 30-day supply of the oral form of naltrexone costs around $48, but you could pay less with insurance and retailer discounts. Extended-release naltrexone generally costs more out of pocket than methadone or buprenorphine does. Actual costs vary, but one study estimated that this treatment costs on average about $48 per day without insurance compared with about $13 per day for methadone and $21 per day for buprenorphine. However, patients with insurance may pay less. In addition, Medicaid and Medicare may cover this treatment. Visit the Centers for Medicare & Medicaid Opioid Prescribing page for more information.
If you are uninsured, are underinsured, or otherwise have trouble paying for treatment, ask a naltrexone treatment center near you whether it can help you obtain free or subsidized care.
Other considerations. This treatment is most effective when combined with supportive counseling or medical care. Because extended-release naltrexone has long-lasting physical effects, carry a card that says you are using this medication; first responders will look for this card in an emergency.
