Naltrexone (brand names Revia and Vivitrol) is a medication used in the treatment of alcohol and opioid use disorders. There are concerns it may lead to liver damage caused by chemicals (hepatoxicity) or interact with other medications.

Doctors often prescribe naltrexone in combination with counseling and behavioral therapies to help treat these substance use disorders.

You may have questions about whether this medication is safe to use if you have hepatitis C. Keep reading for answers to some common questions.

Fast facts

  • Naltrexone is a medication that doctors prescribe as part of a treatment plan for alcohol or opioid use disorders.
  • There is some concern that this medication may lead to liver damage caused by chemicals (hepatoxicity) or may interact with other medications.
  • Discussing hepatitis C infection and your current liver function with your doctor is an important step in determining if this medication is right for you.
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Due to its effects on the liver, there is concern that the drug may lead to liver damage caused by chemicals (hepatoxicity).

However, your doctor may still recommend that you take naltrexone — even if you have hepatitis C. Sometimes, the benefits of this medication may outweigh the risks of liver damage.

Some healthcare professionals suggest that continued use of alcohol or opioids can pose more danger to health than taking naltrexone.

Also, clinical trials and post-marketing use of this medication found that the causes in people who developed hepatoxicity were more likely related to underlying liver diseases or other substances.

Naltrexone may be administered via an intramuscular injection every 4 weeks or daily in tablet form. The Food and Drug Administration (FDA) has approved both versions for adults ages 18 years and older without existing health conditions. However, the oral medication is intended only for the treatment of alcohol use disorder.

Before starting naltrexone, it’s important to discuss all of the risks and side effects versus the intended benefits of this medication.

Talk with your doctor about the following facts to see if naltrexone is appropriate for your condition.

Naltrexone blocks the effects of euphoria and sedation from alcohol and opioids. It also helps decrease cravings for these substances.

Having the hepatitis C virus (HCV) while taking medications that impact your liver might increase your risk of toxic liver damage.

Some experts have observed an increase in liver enzymes that may indicate liver disease in some people taking naltrexone. However, recent 2023 research, however, has found that hepatotoxicity or liver damage did not occur in a small group of people with alcohol use disorder who received an injection of extended-release naltrexone.

A 2022 cohort study also found that naltrexone is safe for underlying liver disease. However, your doctor or healthcare professional will make the ultimate call.

However, alcohol and opioid use disorders can have serious consequences, too.

Continued alcohol consumption is particularly concerning if you have a liver disease such as HCV. It may increase your risk for further complications, such as cirrhosis (scarring) and cancer of the liver.

Thus, your doctor may recommend you take naltrexone to prevent opioids and alcohol from worsening existing liver damage.

Despite its noted safety in research and clinical trials, you should still monitor for symptoms of liver-related events while taking naltrexone if you have HCV. Signs of liver toxicity may include:

Aside from further liver damage, other side effects of this medication include:

Talk with your doctor if you experience any naltrexone side effects. Don’t stop taking this medication unless your doctor tells you to.

Using over-the-counter (OTC) or prescription opioids while taking naltrexone can lead to an increased risk of opioid overdose.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

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Naltrexone is available in tablet and injectable forms. No matter which version your doctor prescribes for you, there’s a possibility that this drug could interact with other OTC and prescription medications. These include:

  • Dextromethorphan (DXM): Some OTC cough syrups and other cough suppressants contain DXM. BRand-name items with this ingredient include Vicks, Robitussin, and Delsym.
  • Loperamide: Some OTC antidiarrheal medications contain loperamide. These include products made by Imodium and Pepto-Bismol. Research has also found that using loperamide for opioid withdrawal can also increase the risk of cardiac emergencies.
  • Prescription opioids: Products include codeine cough syrups, morphine, and hydro- or oxycodone.
  • Acetaminophen (Tylenol): This may increase naltrexone’s effects on your liver.

Before taking naltrexone, tell your doctor about any OTC medications you take, as well as supplements and herbs.

Here are some frequently asked questions about whether you can take naltrexone if you have hepatitis C.

What medications should people with hepatitis avoid?

Medications to avoid if you have hepatitis C include nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

Can you take VIVITROL if you have hepatitis?

Vivitrol is an extended-release, injectable form of naltrexone. Your doctor will determine whether it is suitable for you to take naltrexone if you have hepatitis C.

Can I have any alcohol with hepatitis C?

According to the National Health Service (NHS) in the United Kingdom, drinking alcohol may increase the damage to your liver; it is best to limit your intake or avoid it altogether.

What is the new drug to cure hepatitis C?

Many different medications can treat hepatitis C. Newer medications include elbasvir-grazoprevir.

Naltrexone treats opioid and alcohol use disorders but may increase liver enzymes, potentially leading to hepatoxicity. These effects may concern you if you have a liver disease such as hepatitis C.

However, the current body of research suggests that the benefits of taking this medication outweigh the risks. This is especially the case with alcohol. Exceptions include more severe forms of liver disease as well as liver failure.

Your doctor will help you decide whether you’re a good candidate for naltrexone treatment based on your current health and liver function. While taking this medication, follow your treatment plan carefully and report any adverse reactions to your doctor immediately.