Naltrexone for Cutting Back on Drinking: How Online Care Works

Medication for alcohol use is one of the most underused tools in medicine. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has long pointed out that FDA-approved medicines can help people drink less or stop, yet few people who could benefit are ever offered them. Naltrexone is the one most often prescribed online. Here is how it works and what good telehealth care looks like.

What naltrexone is and how it works

Naltrexone is an opioid receptor blocker. Drinking releases the body's own opioids, which contributes to the pleasurable "buzz" and the urge to keep going. By blocking those receptors, naltrexone can blunt the reward, reduce cravings and make it easier to stop after one or two drinks. It is not a punishment drug: unlike disulfiram, it does not make you sick if you drink.

It comes as a daily tablet and as a monthly injection (Vivitrol), which is given by a clinician. Online services mostly prescribe the tablet. The NIAAA lists naltrexone, acamprosate and disulfiram as the three FDA-approved medicines for alcohol use disorder and notes they are non-addictive and can be prescribed by a primary care provider.

The three FDA-approved options compared

Some clinicians also use other medicines off-label, but the three above are the ones with FDA approval for alcohol use disorder.

Who it suits

Naltrexone may be a good fit if you:

• Want to reduce heavy drinking days or stop entirely.
• Notice strong cravings or difficulty stopping once you start.
• Are not using opioids of any kind, and do not expect to need opioid pain medicine soon.
• Do not have acute hepatitis or liver failure.

You do not have to meet a particular definition of "alcoholism" to talk to a clinician about your drinking. NIAAA's Rethinking Drinking site has tools for gauging your own pattern and describes the range of professional support available.

The opioid issue, explained

Because naltrexone blocks opioid receptors, it can cause sudden, severe withdrawal in someone who has opioids in their system, including prescribed painkillers, some cough medicines and anti-diarrheal products. It also blocks the effect of opioid pain relief, which matters if you need surgery or emergency care. Carry a wallet card or tell any treating clinician you take naltrexone. After stopping naltrexone, opioid tolerance is lower, which raises overdose risk if opioids are used.

What good telehealth care looks like

Several telehealth companies now focus on alcohol, and general primary care and psychiatry services also prescribe naltrexone. A responsible intake asks about:

• How much and how often you drink, and whether you have had withdrawal symptoms such as shakes, sweats or seizures
• Any opioid use, prescribed or otherwise
• Liver disease, hepatitis, kidney problems
• Mental health, including depression and suicidal thoughts
• Pregnancy

Expect lab work, typically liver tests, ordered at a local lab before or soon after starting. Naltrexone is not a controlled substance, so it is not subject to the special telehealth prescribing rules that cover some other medicines. Our article on controlled substances and telehealth explains that distinction.

What to expect once you start

• Common side effects include nausea, headache, dizziness and tiredness, which often ease after the first weeks.
• Some programs suggest taking naltrexone daily; others use a "targeted" approach, taking it before situations where drinking is likely. Follow your prescriber's plan.
• Track your drinks. Seeing the trend helps you and your clinician judge whether it is working.
• Follow-up visits check side effects, labs and progress, and adjust the plan.

How to tell if it is working

Progress with naltrexone is usually measured in drinking patterns rather than feelings. Useful markers to track and share with your clinician:

• Heavy drinking days per week or month, which is often the first number to move.
• Total drinks per week, counted honestly using standard drink sizes.
• Days without alcohol.
• Cravings, rated on a simple scale.
• Consequences: sleep, work, mood, arguments, hangovers.

NIAAA's Rethinking Drinking site has drink-size charts and calculators that make counting easier. If nothing has changed after a fair trial, the plan should change, whether that is adding more support, adjusting how naltrexone is taken, or trying a different medicine such as acamprosate.

Privacy and records

Many people hesitate to seek alcohol treatment because of privacy worries. Telehealth visits fall under the same health privacy rules as in-person care, and records from federally assisted substance use disorder programs carry additional protections. It is still worth reading a service's privacy policy, especially for apps. Our telehealth privacy primer explains what happens to your data after a visit.

A note on naltrexone in weight-loss combos

You may have seen naltrexone as part of a weight-loss medicine combined with bupropion. That is a different product and purpose. Our article on weight loss options beyond GLP-1s covers it. If you are on that combination, do not add separate naltrexone without your prescriber's input.

When in-person care is the better choice

Seek in-person or specialist care if you have had withdrawal seizures or delirium tremens before, drink heavily every day, have significant liver disease, use opioids, or have serious mental health symptoms. Telehealth can still be part of the plan, but the starting point may need to be a clinic or treatment program. The NIAAA Alcohol Treatment Navigator helps you find and evaluate options.