At Porch Light Health, we offer naltrexone therapy at locations throughout Colorado and New Mexico. This comprehensive guide will help you understand what side effects you might experience, how to manage them effectively, and when to seek medical attention.
Key difference from other MAT medications: Naltrexone contains no opioid component, meaning it:
Cannot get you “high” or cause euphoria
Doesn’t cause physical dependence
Won’t lead to withdrawal when stopped
Requires complete opioid detoxification before starting
Has a different side effect profile than opioid agonist medications
Common Side Effects of Naltrexone
Most people tolerate naltrexone well when it is prescribed and monitored through a structured naltrexone treatment program, and side effects are generally mild and temporary. The side effect profile differs significantly between oral naltrexone and the Vivitrol injection.
Nausea
Nausea is the most commonly reported side effect of naltrexone, particularly with oral formulations. According to research published in the National Library of Medicine, nausea typically occurs during the first few weeks of treatment and often improves as your body adjusts.
Management strategies:
Take oral naltrexone with food
Start with lower doses and gradually increase (if prescribed)
Eat small, frequent meals throughout the day
Avoid greasy, spicy, or heavy foods
Stay hydrated with water or ginger tea
Take medication at bedtime to sleep through peak side effects
Consider anti-nausea medications if symptoms are severe
If nausea persists beyond the first few weeks or becomes severe, contact your healthcare provider. The injectable Vivitrol formulation often causes less nausea than oral naltrexone.
Headache
Headaches are common during the initial weeks of naltrexone treatment but typically decrease over time.
Tips for managing headaches:
Stay well-hydrated throughout the day
Maintain regular sleep patterns
Practice stress-reduction techniques
Use over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil)
Track headache patterns to identify triggers
Ensure you’re eating regular meals
Persistent or severe headaches should be discussed with your treatment team during your treatment journey.
Fatigue and Tiredness
Some people experience fatigue or decreased energy during the first few weeks of naltrexone treatment. This usually improves as your body adjusts.
Strategies to combat fatigue:
Get adequate sleep (7-9 hours nightly)
Engage in regular physical activity
Eat a balanced, nutritious diet
Take the medication at bedtime if daytime fatigue is problematic
Limit caffeine, especially in afternoon and evening
Practice good sleep hygiene
If fatigue persists or interferes significantly with daily activities, discuss dosing adjustments with your provider.
Dizziness and Lightheadedness
Mild dizziness can occur when starting naltrexone, particularly when standing up quickly.
Safety precautions:
Stand up slowly from sitting or lying positions
Stay well-hydrated
Avoid alcohol entirely (which can worsen dizziness)
Be cautious when driving until you know how naltrexone affects you
Sit or lie down if you feel dizzy
Severe or persistent dizziness warrants medical evaluation to rule out other causes.
Injection Site Reactions (Vivitrol)
The Vivitrol injection commonly causes localized reactions at the injection site (typically the buttocks). According to the FDA, these reactions are usually mild to moderate.
Common injection site reactions include:
Pain or tenderness
Redness
Swelling
Bruising
Hardness or lump at injection site
Itching
Managing injection site reactions:
Apply ice packs for the first 24-48 hours
Use warm compresses after 48 hours to help medication absorb
Take over-the-counter pain relievers as needed
Wear loose-fitting clothing
Avoid massaging or rubbing the injection site
Alternate injection sites (right and left buttocks) each month
Most injection site reactions resolve within a few days to two weeks. Severe pain, increasing redness, warmth, or signs of infection require immediate medical attention.
Insomnia and Sleep Disturbances
Some people experience difficulty sleeping when starting naltrexone therapy.
Sleep improvement strategies:
Take oral naltrexone in the morning rather than evening
Maintain consistent sleep and wake times
Create a relaxing bedtime routine
Limit screen time before bed
Keep bedroom cool, dark, and quiet
Avoid caffeine after early afternoon
Practice relaxation techniques like deep breathing or meditation
If sleep problems persist, your healthcare provider may recommend adjusting dosing time or prescribe short-term sleep aids.
Anxiety and Nervousness
Mild anxiety or nervousness can occur during the initial treatment period, though this is less common than other side effects.
If you have a history of anxiety disorders or if anxiety becomes severe, discuss this with your treatment team. Porch Light Health specializes in dual diagnosis treatment for co-occurring mental health and substance use disorders.
Appetite Changes and Weight Loss
Some people experience decreased appetite during naltrexone treatment, particularly in the first few weeks. This can lead to modest weight loss.
Maintaining healthy nutrition:
Eat small, frequent meals even if not hungry
Focus on nutrient-dense foods
Track your weight weekly
Set reminders to eat if you forget
Consider working with a nutritionist
Notify your provider if weight loss is significant
Unlike some MAT medications, naltrexone typically doesn’t cause significant weight gain.
Muscle and Joint Pain
Mild muscle aches or joint pain can occur during naltrexone treatment, though this is relatively uncommon.
Relief strategies:
Use over-the-counter pain relievers (acetaminophen or ibuprofen)
Apply heat or cold to affected areas
Engage in gentle stretching
Stay physically active
Ensure adequate hydration
Get adequate rest
Less Common but Serious Side Effects
While rare, some side effects require immediate medical attention.
Liver Damage and Hepatotoxicity
At high doses (much higher than those used for addiction treatment), naltrexone can potentially affect liver function. However, at standard treatment doses (50mg oral or 380mg monthly injection), liver problems are rare.
Severe abdominal pain, especially upper right side
Unusual fatigue or weakness
Loss of appetite beyond initial nausea
Easy bruising or bleeding
Before starting naltrexone, your healthcare provider will typically check liver function through blood tests. Regular monitoring may be recommended, especially if you have risk factors. According to the National Institute on Drug Abuse (NIDA), liver problems with naltrexone are uncommon when the medication is used appropriately.
Severe Allergic Reactions
Though rare, severe allergic reactions to naltrexone can occur.
Symptoms requiring immediate medical attention:
Difficulty breathing or shortness of breath
Swelling of face, lips, tongue, or throat
Severe rash or hives
Rapid heartbeat
Chest tightness
Dizziness or fainting
Call 911 if you experience symptoms of a severe allergic reaction.
Not sure what kind of help you need? Our team can walk you through your options, including insurance and Medicaid.
This is the most serious risk associated with naltrexone treatment. Because naltrexone is an opioid antagonist, taking it while opioids are still in your system can cause sudden, severe withdrawal symptoms called precipitated withdrawal.
Critical timing requirements:
Must be completely opioid-free for 7-10 days before starting oral naltrexone
Must be opioid-free for 10-14 days before Vivitrol injection
Longer waiting period needed if you used long-acting opioids like methadone or Sublocade
Even trace amounts of opioids can trigger precipitated withdrawal
Symptoms of precipitated withdrawal include:
Severe anxiety and restlessness
Intense muscle aches and pains
Excessive sweating
Rapid heartbeat
Nausea and vomiting
Diarrhea
Dilated pupils
Goosebumps and chills
To prevent precipitated withdrawal, your healthcare provider may use the COWS assessment (Clinical Opiate Withdrawal Scale) to ensure you’re in sufficient withdrawal before starting naltrexone. Some programs use a naloxone challenge test to confirm opioid clearance.
If you experience precipitated withdrawal:
Contact your healthcare provider immediately
Go to the emergency room if symptoms are severe
Be honest about any recent opioid use
Symptoms typically resolve within 24-48 hours
Depression and Suicidal Thoughts
While naltrexone itself doesn’t directly cause depression, some people report mood changes during treatment. The relationship is complex:
Recovery from addiction can involve confronting difficult emotions
Stopping opioid or alcohol use changes brain chemistry
Underlying depression may become more apparent without substances masking symptoms
Loss of the “reward” feeling from substances requires adjustment
Warning signs to watch for:
Persistent sad or “empty” mood
Loss of interest in activities once enjoyed
Changes in sleep or appetite beyond initial side effects
Risk is highest immediately after stopping naltrexone
Vivitrol’s effects can last up to 60 days after injection
Always inform emergency personnel if you’re on naltrexone
If you’re considering stopping naltrexone, discuss it with your treatment team first. Never attempt to “override” naltrexone’s blocking effects by using large amounts of opioids—this can be fatal.
Eosinophilic Pneumonia (Rare)
In very rare cases, naltrexone injections have been associated with eosinophilic pneumonia, a serious lung condition.
Symptoms include:
Progressive difficulty breathing
Cough
Chest pain
Fever
This typically occurs within the first month after injection. Seek immediate medical attention if you experience these symptoms.
Naltrexone Side Effects Timeline
Understanding the timeline helps you know what to expect at each stage.
Week 1: Initial Adjustment
During your first week on naltrexone:
Nausea is most likely during this period
Headaches may occur
Mild fatigue or tiredness
Injection site discomfort (if using Vivitrol)
Sleep changes may begin
Your body is adjusting to the medication
For Vivitrol, injection site reactions peak within the first few days and gradually improve over 1-2 weeks.
Weeks 2-4: Stabilization Period
By weeks 2-4:
Nausea typically improves significantly
Headaches become less frequent
Energy levels begin normalizing
Sleep patterns start to stabilize
Injection site reactions resolve (Vivitrol)
You’re adapting to life without opioids or alcohol
This is when the benefits of naltrexone become more apparent—reduced cravings and less interest in using substances.
Month 2 and Beyond: Long-Term Maintenance
After the first month:
Most side effects have resolved
Rare ongoing effects include mild nausea or occasional headaches
New injection site reaction each month (Vivitrol)
Focus shifts to recovery work and lifestyle rebuilding
Regular follow-up appointments help monitor progress
Oral Naltrexone vs. Vivitrol: Side Effect Differences
The two formulations have different side effect profiles.
Oral Naltrexone (Daily Tablet)
Advantages:
Can adjust dose more easily
Can stop immediately if problems occur
Lower cost (generic available)
No injection site reactions
Easier to start and stop
Disadvantages:
Higher rates of nausea
Requires daily adherence
Peak blood levels may cause more acute side effects
Easy to skip doses or discontinue impulsively
Common side effects:
Nausea (most common)
Headache
Dizziness
Fatigue
Anxiety
Vivitrol (Monthly Injection)
Advantages:
Taken only once monthly
Ensures medication adherence
Steady blood levels (fewer peaks and valleys)
Generally less nausea than oral
Can’t skip doses impulsively
Disadvantages:
Injection site reactions
Can’t stop immediately if side effects occur
Effects last 28-30 days (up to 60 days)
More expensive
Requires healthcare visits for administration
Common side effects:
Injection site reactions (most common)
Headache
Fatigue
Nausea (less common than oral)
Most people find Vivitrol more convenient and easier to tolerate long-term, though individual experiences vary, and patients on low-dose protocols often look into the long-term side effects of low-dose naltrexone as a related consideration. At Porch Light Health, we can help you decide which formulation best fits your needs and lifestyle.
Managing and Minimizing Naltrexone Side Effects
While you can’t prevent all side effects, several strategies can minimize their impact.
Proper Medication Timing
For oral naltrexone:
Take at the same time daily for consistency
Take with food to reduce nausea
Consider bedtime dosing if experiencing daytime side effects
Don’t skip doses, as this doesn’t allow your body to adjust
For Vivitrol:
Schedule injections consistently (every 28 days)
Don’t delay injections, as protection decreases
Plan injection appointments when you can rest afterward
Follow aftercare instructions for injection site
Lifestyle Modifications
Healthy habits support your recovery and reduce side effects:
This antipsychotic medication should not be combined with naltrexone due to increased risk of serious side effects.
Disulfiram (Antabuse)
When combined with naltrexone, both medications can affect the liver. If used together, careful liver monitoring is required. Some treatment programs successfully use both medications concurrently with appropriate supervision.
Most anxiety medications (though benzodiazepine use is discouraged in recovery)
Over-the-Counter Medications
Safe to use:
Acetaminophen (Tylenol) for pain or fever
Ibuprofen (Advil, Motrin) for pain or inflammation
Most cold and flu medications (check labels for codeine)
Antihistamines for allergies
Avoid:
Any medications containing opioids (codeine, hydrocodone)
“PM” formulations of pain relievers that contain sleep aids and opioids
Always read medication labels carefully and consult with your pharmacist if unsure.
Naltrexone vs. Other MAT Options: Side Effect Comparison
Understanding how naltrexone compares to other medications helps inform treatment decisions.
Naltrexone vs. Buprenorphine (Suboxone, Sublocade, Brixadi)
Buprenorphine is a partial opioid agonist, while naltrexone is a pure antagonist.
Naltrexone:
No opioid component (non-addictive)
No physical dependence or withdrawal
No sedation or “high”
Requires full detox before starting (7-14 days opioid-free)
Risk of precipitated withdrawal if started too soon
No respiratory depression risk
Fewer side effects overall
Cannot be used for pain management
Buprenorphine:
Contains opioid activity (partial agonist)
Can cause physical dependence
Mild sedation possible
Can start while in early withdrawal
Risk of precipitated withdrawal exists but less severe
Ceiling effect limits respiratory depression
More side effects (constipation, sweating, etc.)
Provides some pain relief
Naltrexone works best for people who:
Can successfully complete detoxification
Don’t have chronic pain requiring opioid management
Want complete abstinence from all opioids
Have shorter addiction histories or less severe addiction
Have strong motivation and support systems
At Porch Light Health, we offer naltrexone, Suboxone, Sublocade, and Brixadi, allowing us to match you with the best medication for your specific situation.
Naltrexone vs. Methadone
Methadone is a full opioid agonist requiring specialized clinic attendance.
Naltrexone:
No opioid activity
Can be prescribed in standard medical offices
Monthly injections or daily pills
No sedation or impairment
No risk of diversion or misuse
Fewer overall side effects
No daily clinic requirement
Methadone:
Full opioid agonist
Requires daily clinic visits (initially)
Significant sedation possible
Higher side effect burden
Provides excellent craving control
Better for severe, long-standing addiction
More appropriate for people with chronic pain
Methadone may be better for people with:
Very severe, long-standing addiction
Multiple failed attempts with other treatments
Chronic pain requiring opioid management
High tolerance to opioids
We offer methadone treatment at our Denver and Lakewood clinics for those who need this level of care.
Special Populations and Considerations
Certain groups require special attention with naltrexone treatment.
Consider alternative MAT if chronic pain is significant
Always inform all healthcare providers, especially dentists and surgeons, that you’re on naltrexone.
Adolescents
Naltrexone can be used in adolescents age 18 and older. For younger teens, use is off-label and requires careful consideration.
Older Adults
Seniors may tolerate naltrexone well, but considerations include:
Higher likelihood of liver issues
Multiple medications increasing interaction risk
May need dose adjustments
Closer monitoring recommended
Special Populations
Veterans: We offer specialized support for veterans dealing with opioid or alcohol use disorders.
First Responders: Our first responder program understands unique challenges faced by police, firefighters, and EMS personnel.
When to Contact Your Healthcare Provider
Know when to seek help for naltrexone-related concerns.
Call 911 immediately if you experience:
Severe difficulty breathing
Signs of severe allergic reaction (swelling, hives, throat tightness)
Symptoms of precipitated withdrawal (if you may have taken opioids)
Thoughts of suicide or self-harm
Severe chest pain
Contact your healthcare provider within 24 hours if you experience:
Signs of liver problems (jaundice, dark urine, severe fatigue)
Severe or persistent nausea and vomiting
Severe depression or mood changes
Injection site signs of infection (increasing pain, warmth, pus)
Severe allergic reactions
Discuss at your next appointment:
Mild ongoing side effects
Questions about pain management
Interest in switching formulations (oral to injection or vice versa)
Concerns about treatment effectiveness
Life changes affecting your treatment
Myths and Misconceptions About Naltrexone
Common myths can create unnecessary concerns.
Myth: “Naltrexone is just replacing one drug with another.”
Reality: Naltrexone contains no addictive substances. It’s a pure antagonist that blocks opioid receptors without activating them. You cannot get “high” from naltrexone, and it doesn’t cause physical dependence. According to SAMHSA, it’s a non-addictive medication that supports recovery.
Myth: “You can still use opioids while on naltrexone if you use enough.”
Reality: This is extremely dangerous. Attempting to override naltrexone’s blockade by using large amounts of opioids can cause fatal overdose. The blocking effect is strong, and trying to overcome it puts you at severe risk.
Myth: “Naltrexone doesn’t work for alcohol addiction.”
Myth: “You can’t take naltrexone if you have Hepatitis C.”
Reality: While naltrexone does require liver monitoring, Hepatitis C itself isn’t an absolute contraindication. Many people with Hepatitis C successfully use naltrexone with appropriate monitoring. Active, acute hepatitis or severe liver disease would preclude use.
Myth: “Vivitrol is better than oral naltrexone.”
Reality: Both formulations are effective. Vivitrol ensures medication adherence since it’s administered monthly by healthcare providers, but oral naltrexone offers more flexibility and lower cost. The “best” option depends on your individual circumstances, preferences, and needs.
Myth: “Naltrexone causes severe depression.”
Reality: Naltrexone doesn’t directly cause depression. However, recovery from addiction can involve confronting difficult emotions that were previously masked by substances. Some people experience mood changes as they adjust to sobriety. This emphasizes the importance of combining medication with therapy and support.
The Role of Counseling and Support
Naltrexone is most effective when combined with comprehensive behavioral health services.
How counseling enhances naltrexone treatment:
Addressing underlying issues: Therapy helps resolve trauma, mental health conditions, and relationship problems
Developing coping skills: Learn healthy ways to manage stress, emotions, and triggers
Building support systems: Strengthen connections with others in recovery
Preventing relapse: Identify warning signs and develop prevention strategies
Managing side effects: Learn practical strategies for handling discomfort
Our integrated approach treats the whole person, not just the addiction.
Your Path Forward with Naltrexone
Side effects are a consideration with any medication, but naltrexone generally has a favorable side effect profile compared to other addiction treatment medications. Most side effects are mild, temporary, and manageable. The benefits of naltrexone—freedom from active addiction, reduced cravings, normal functioning, and the opportunity to rebuild your life—typically far outweigh any temporary discomfort.
Naltrexone has helped thousands of people achieve long-term recovery from opioid use disorder and alcohol use disorder, including many who began with treatment for heroin addiction. With proper medical supervision, honest communication with your treatment team, and commitment to comprehensive recovery, you can successfully manage any side effects while benefiting from this effective medication.
You don’t have to face addiction alone. Recovery is possible, and we’re here to support you every step of the way.
Start Your Recovery Journey at Porch Light Health
Porch Light Health provides comprehensive naltrexone therapy at locations throughout Colorado and New Mexico. Our experienced team is committed to supporting your recovery with compassionate, evidence-based care.
Insurance Plans
Affordable rates for uninsured or out-of-pocket payers.
This practice serves all patients regardless of inability to pay. A sliding fee scale for medical and behavioral addiction services is offered based on family size and income. For more information, please contact us at 1-866-394-6123 and speak with a representative.
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porchlighthealth.com
November 6, 2026
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