• Naltrexone is a medication that may be used 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.

Naltrexone (brand names Revia and Vivitrol) is a medication used in the treatment of alcohol and opioid use disorders as part of a medication-assisted treatment (MAT) program.

This means it may be used in combination with counseling and behavioral therapies as treatment for 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.

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. In some cases, the benefits of this medication may outweigh the risks of liver damage.

In fact, 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 provided via an intramuscular injection every 4 weeks or daily in tablet form. Both versions are approved for adults 18 years of age and older, though the oral medication is intended only for the treatment of alcohol use disorder.

Before getting started with naltrexone, it’s important to discuss all of the risks and side effects versus the intended benefits of this drug.

Talk with your doctor about the following facts to see if taking 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 may, in theory, increase your risk of toxic liver damage.

An increase in liver enzymes that may indicate liver disease has been observed in some people taking naltrexone. The way that naltrexone may cause liver damage is currently unknown.

However, alcohol and opioid use disorders 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 taking naltrexone in an effort to prevent opioid and alcohol injury to an already damaged liver.

Another consideration is the severity of HCV. One study of males with liver disease and opioid dependence found that injectable naltrexone was safe in participants who had mild to moderate HCV. At the same time, naltrexone is not recommended for people with acute liver failure.

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:

  • yellowing of the eyes and skin (jaundice)
  • chronic stomach pain
  • dark urine
  • excessive fatigue

Aside from further liver damage, there are other side effects of this medication to consider, such as:

  • chronic nausea or vomiting
  • skin irritation at the site of injection (with intramuscular versions only)
  • daytime sleepiness
  • insomnia
  • decreased appetite
  • dizziness
  • headache
  • toothaches
  • nasal symptoms similar to a cold
  • joint or muscle aches
  • depression
  • suicidal thoughts

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

By using OTC or prescription opioids while taking naltrexone, there is also an increased risk of opioid overdose.

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 over-the-counter (OTC) and prescription medications. These include:

  • Dextromethorphan (DXM), an ingredient found in some OTC cough syrups and other cough suppressants. Some brand names with this ingredient include Vicks, Robitussin, and Delsym.
  • Loperamide, which is found in some OTC antidiarrheal medications. Examples 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, including codeine cough syrups, morphine, and hydro- or oxycodone.
  • Acetaminophen (Tylenol), which 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. You will also be required to stop taking opioids 7 to 10 days before starting this medication.

Naltrexone, a medication used to treat opioid and alcohol use disorders, may increase liver enzymes and carry the risk of hepatoxicity. Such effects may be concerning 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 cases of 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, be sure to follow your treatment plan carefully and report any adverse reactions to your doctor right away.