naltrexone

Adjunctive therapy

Brands: Revia, Depade

Last reviewed 2026-02-12

Reviewed by PsychMed Editorial Team.

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Quick answers

What is naltrexone?
Naltrexone (brands Revia/Depade; many generics) is an opioid receptor antagonist used to support treatment of alcohol dependence and to block the effects of exogenous opioids in opioid dependence management (label).
What is Revia?
Revia is a brand name for naltrexone (other brands: Depade).
What is Revia (naltrexone) used for?
Label indications include: Treatment of alcohol dependence; blockade of the effects of exogenously administered opioids in the management of opioid dependence (label).
What drug class is Revia (naltrexone)?
Opioid receptor antagonist used for alcohol dependence and for opioid dependence relapse prevention via opioid blockade; requires an opioid-free period to avoid precipitated withdrawal and has hepatotoxicity cautions at higher doses.
What strengths does Revia (naltrexone) come in?
Tablets: 50 mg (label/manufacturer-dependent).

Snapshot

Class: Adjunctive therapy
Common US brands: Revia, Depade
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2026-02-12

Label indications

Treatment of alcohol dependence; blockade of the effects of exogenously administered opioids in the management of opioid dependence (label).

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Clinical Highlights

Naltrexone (brands Revia/Depade; many generics) is an opioid receptor antagonist used to support treatment of alcohol dependence and to block the effects of exogenous opioids in opioid dependence management (label). It does not treat acute alcohol or opioid withdrawal. Its role is typically relapse prevention and craving reduction as part of a broader treatment plan (label/clinical).

For opioid use disorder (OUD), an opioid-free period is required before initiation because naltrexone can trigger precipitated withdrawal in physically dependent individuals (label).
Liver safety is a key consideration. The label describes hepatocellular injury risk at higher doses and emphasizes avoiding use in acute hepatitis or liver failure; baseline and follow-up liver testing is common in practice (label/clinical).
The compare view, naltrexone evidence feed, and naltrexone print page help contextualize adverse-effect and safety profiles in common comorbidity regimens.

Dosing & Formulations

Tablets: 50 mg (label/manufacturer-dependent). Alcohol dependence: 50 mg once daily was used in placebo-controlled outpatient trials for up to 12 weeks (label).

Opioid dependence relapse prevention: the label describes starting with 25 mg and, if no withdrawal signs occur, continuing with 50 mg daily thereafter (label).
Alternative supervised dosing schedules (e.g., higher doses at longer intervals) are described in labeling, but hepatotoxicity risk may increase with single doses above 50 mg and scheduling decisions balance risks and benefits (label/clinical).
Clinicians often document opioid-free verification strategy when opioid use disorder is present, recognizing that no method is completely reliable and precipitated withdrawal can be severe (label/clinical).

Monitoring & Risks

Precipitated opioid withdrawal is the main acute risk when opioids are still present; careful screening and planning is standard before initiation (label). Hepatotoxicity risk increases at higher doses; baseline and follow-up liver testing is common, especially when alcohol-related liver disease is present (label/clinical).

Nausea, headache, dizziness, and fatigue are common adverse effects; early follow-up often focuses on tolerability and adherence (label/clinical).
Opioid analgesia will be reduced or blocked while on naltrexone; care planning for procedures or acute pain episodes is clinically important (label/clinical).
If naltrexone is stopped, opioid tolerance may be reduced, increasing opioid overdose risk if opioids are resumed; harm-reduction counseling is often part of care (clinical).

Drug Interactions

Opioid-containing medications (analgesics, antidiarrheals, cough suppressants) can be ineffective while on naltrexone and may precipitate withdrawal if opioid dependence is present; medication list review is central (label/clinical). In practice, teams often coordinate around perioperative pain plans because standard opioid strategies may be ineffective while naltrexone is active (clinical).

Hepatotoxic co-medications or heavy alcohol use can compound liver risk, so broader regimen review is common when liver enzymes are elevated (clinical).

Practice Notes

Evidence syntheses support oral naltrexone (50 mg/day) as one effective option for alcohol use disorder (AUD), but benefit depends on adherence and integration with psychosocial supports (Jonas 2014/clinical). For opioid use disorder (OUD), adherence barriers are common with oral formulations; extended-release injectable naltrexone exists, but is a distinct formulation and implementation pathway (clinical).

Patient selection often centers on liver safety, opioid exposure status, and the feasibility of daily dosing and follow-up (clinical).

References

Naltrexone hydrochloride tablets prescribing information — DailyMed (2026)
Pharmacotherapy FOR Adults With Alcohol USE Disorders IN Outpatient Settings: A Systematic Review AND Meta Analysis — JAMA (2014)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)