Last Updated on July 1, 2026

Naltrexone interactions are fairly uncommon, but a few are important to know before starting treatment. The most significant interaction is with opioids, which can trigger sudden withdrawal or prevent opioid pain medicines from working. Naltrexone may also require additional monitoring when taken alongside certain prescription medications or if you have liver disease. Before starting treatment, give your clinician a complete list of every prescription medication, over-the-counter medicine, and supplement you take.

If you’ve been researching naltrexone to help you cut back on drinking, you may have found yourself wondering, Can I take this with my antidepressant? What if I need surgery? Is ibuprofen okay? These are smart questions to ask.

Unlike some medications, naltrexone doesn’t interact with dozens of common prescriptions. In fact, many people can continue taking their existing medications without any problems. The important exceptions, though, can be serious, which is why your healthcare provider should always review your medication list before prescribing naltrexone.

At Sunnyside Med, every prescription starts with a clinical evaluation. Before recommending compounded naltrexone, a licensed provider reviews your health history, current medications, and any conditions that could affect whether the medication is appropriate for you.

“We’re building Sunnyside Med to provide proactive and preventive access to medication before alcohol becomes a massive negative part of your story,” says Sunnyside co-founder Nick Allen.

Here’s what you should know about the most important naltrexone interactions.

The Most Important Naltrexone Interaction: Opioids

Unlike many medications, naltrexone has relatively few clinically significant drug interactions. Opioids are the major exception, which is why healthcare providers spend so much time discussing them before treatment begins.

Naltrexone is an opioid receptor antagonist. It sits on the opioid receptors in your brain and blocks other opioids from attaching to them. That’s part of how it helps reduce alcohol’s rewarding effects, but it also means opioid medications won’t work normally while naltrexone is active.

For someone who still has opioids in their system, starting naltrexone can trigger what’s called precipitated withdrawal. Rather than withdrawal developing gradually, symptoms can come on quickly because naltrexone suddenly displaces opioids from their receptors.

Symptoms may include:

• Severe nausea or vomiting
• Sweating and chills
• Muscle aches
• Anxiety
• Abdominal cramping or diarrhea
• Rapid heart rate

Because of this risk, healthcare providers generally recommend stopping opioid medications before starting naltrexone. The amount of time you’ll need to wait depends on the specific opioid you were taking, how long you were taking it, and other individual factors. Your clinician will determine what’s appropriate for your situation.

Don’t forget hidden sources of opioids

Many people think of opioids only as prescription pain medications, but they can also appear in medications you might not immediately recognize.

Examples include:

• Prescription cough syrups containing codeine
• Certain prescription medications used to treat diarrhea that contain opioid ingredients
• Pain medication prescribed after dental procedures or surgery
• Combination prescription products that include hydrocodone, oxycodone, or tramadol

Always read ingredient labels, and let every healthcare provider know you’re taking naltrexone before accepting a new prescription.

What if you need surgery?

If you have a planned procedure, tell your surgeon and anesthesiologist that you’re taking naltrexone as early as possible. They may recommend temporarily stopping the medication before surgery or reviewing your post-surgery plan if opioid pain management is expected.

Don’t stop taking naltrexone on your own before surgery. Your healthcare team will recommend whether and when it should be paused based on the procedure and your expected pain management needs.

Common Prescription Medication Interactions

Outside of opioids, naltrexone has relatively few clinically significant drug interactions. Even so, there are medications your healthcare provider should know about before you start treatment.

Antidepressants

One of the most common questions people ask is whether they can take naltrexone with an antidepressant. For most people, the answer is yes. There are no well-established drug interactions between naltrexone and commonly prescribed SSRIs or SNRIs, including medications like sertraline (Zoloft), escitalopram (Lexapro), or duloxetine (Cymbalta). In fact, some clinical studies have evaluated naltrexone alongside antidepressants in people with alcohol use disorder.

That doesn’t mean you should combine medications on your own. Every antidepressant has its own side effect profile, and your healthcare provider will want to monitor how you’re feeling after starting any new medication.

Acamprosate

Acamprosate is another FDA-approved medication that helps people change their relationship with alcohol.

Unlike naltrexone, which works on the brain’s opioid reward system, acamprosate helps restore balance to neurotransmitters that can become disrupted after long periods of heavy drinking.

Because they work through different mechanisms, the two medications are sometimes prescribed together.

There isn’t a known harmful drug-drug interaction between acamprosate and naltrexone. However, both medications can cause gastrointestinal side effects in some people, so your provider may recommend monitoring how you feel during the first few weeks.

Disulfiram (Antabuse)

Disulfiram works very differently from naltrexone. Instead of reducing alcohol’s rewarding effects, disulfiram causes an unpleasant physical reaction if alcohol is consumed.

Although these medications aren’t absolutely contraindicated together, they should be combined cautiously because both can affect liver function. If your provider believes both medications are appropriate, they may recommend periodic liver function testing while you’re taking them.

Sedatives and sleep medications

Naltrexone itself is not a sedative (though it may have temporary sleep-related side effects). However, if you’re taking medications that cause drowsiness, such as benzodiazepines, prescription sleep medications, or certain muscle relaxants, your healthcare provider may want to review the combination.

The concern isn’t that naltrexone directly interacts with these medications. Rather, overlapping side effects like dizziness, fatigue, or impaired concentration may be more noticeable, particularly when you’re first starting treatment. In many cases, these medications can still be used together under medical supervision, so be sure to discuss your particular situation with your clinician.

Before You Start Naltrexone

The safest approach is also the simplest: tell your healthcare provider everything you’re taking.

That includes:

• Prescription medications
• Over-the-counter medications
• Vitamins
• Herbal supplements
• Recreational substances

Even if a medication doesn’t have a known interaction with naltrexone, your provider may still want to consider your overall health, liver function, treatment goals, and other medical conditions before deciding whether naltrexone is the right fit.

That’s one advantage of working with a program like Sunnyside Med. Before prescribing compounded naltrexone, licensed providers review your complete medication list and medical history so they can identify potential concerns before you ever take your first dose.

Over-the-Counter Medications, Supplements, and Other Naltrexone Interactions

Most over-the-counter medications don’t directly interact with naltrexone. Still, it’s worth knowing which products are generally considered safe, which deserve extra caution, and when it’s time to check with your healthcare provider.

Can You Take Tylenol or Ibuprofen With Naltrexone?

This is one of the most common questions people ask before starting treatment.

Tylenol (acetaminophen)

There isn’t a direct interaction between acetaminophen (Tylenol) and naltrexone. However, both medications are processed through the liver to some extent.

For most healthy adults taking recommended doses, this isn’t a problem. But if you have liver disease, regularly take high doses of acetaminophen, or drink heavily, your healthcare provider may recommend limiting acetaminophen use or monitoring your liver function more closely.

Never exceed the maximum daily dose of acetaminophen, and remember that it’s included in many combination cold, flu, and pain medications.

Ibuprofen (Advil, Motrin)

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) don’t have a known drug interaction with naltrexone.

For most people, they’re considered safe to use together when taken as directed. As always, NSAIDs carry their own risks—including stomach irritation, kidney problems, and increased bleeding risk in some people—so follow the package directions or your provider’s recommendations.

Cold, Flu, and Cough Medications

This category deserves a little extra attention because some products contain opioid ingredients.

Most over-the-counter cough and cold medications are compatible with naltrexone. However, certain prescription cough syrups contain codeine or hydrocodone, which are opioids. Because naltrexone blocks opioid receptors, these medications may not work as intended and could trigger withdrawal in someone who is opioid-dependent.

When choosing a cough medicine, it’s a good habit to check the active ingredients or ask your pharmacist if you’re unsure.

Supplements, Herbal Products, and Cannabis

Natural doesn’t always mean interaction-free.

Although relatively little research has examined herbal supplements alongside naltrexone, it’s still important to tell your healthcare provider about everything you take.

Herbal supplements

Most vitamins don’t have known interactions with naltrexone.

Herbal supplements are different because many haven’t been studied extensively for drug interactions.

Products that may merit additional discussion include:

• St. John’s wort
• Kava
• Kratom
• High-dose herbal liver supplements

These don’t necessarily interact directly with naltrexone, but some can affect the liver, alter how medications are processed, or have their own sedating effects. Your healthcare provider can help determine whether any supplements should be stopped or monitored.

Cannabis

Research hasn’t identified a direct drug interaction between cannabis and naltrexone.

That’s because they act on different receptor systems in the brain. Naltrexone blocks opioid receptors, while cannabis primarily acts on cannabinoid receptors.

That said, using cannabis while taking naltrexone can still influence how you feel. Both substances may affect concentration, coordination, mood, or motivation in different ways. If you use cannabis regularly, let your provider know before starting naltrexone so they can give guidance based on your overall health and treatment goals.

Medical Conditions That May Affect Naltrexone

Certain health conditions can affect whether naltrexone is appropriate or whether additional monitoring is needed.

Liver disease

Naltrexone is metabolized by the liver, so people with active liver disease may need additional evaluation before starting treatment.

This doesn’t automatically mean you can’t take naltrexone. In fact, many people with mild or stable liver disease are still candidates. Your provider may recommend liver function tests before treatment begins and periodically afterward.

It’s also worth remembering that heavy alcohol use itself is often much harder on the liver than naltrexone. For many people, reducing alcohol consumption ultimately lowers their long-term liver risk.

Kidney disease

Kidney disease is generally less of a concern than liver disease, but reduced kidney function can affect how medications move through your body.

If you have significant kidney disease, your provider will determine whether any adjustments or additional monitoring are appropriate.

Current opioid use

This is a very important interaction. Even if you’re only taking opioids occasionally, your provider needs to know.

Starting naltrexone too soon after opioid use can cause sudden withdrawal, so being honest about every medication you take is one of the most important parts of staying safe.

A Simple Way to Stay Safe

Reading about drug interactions can feel intimidating. The good news is that most people taking naltrexone don’t run into significant medication problems. The biggest safety issue—opioids—is well understood and easy to avoid once you know about it.

The most important thing you can do is keep an up-to-date medication list and share it with every healthcare provider you see. That includes prescriptions, over-the-counter medications, supplements, and recreational substances.

When your provider has the full picture, they can identify potential interactions before they become problems.

How Sunnyside Med Can Help with Naltrexone Interactions

Starting a new medication naturally comes with questions. That’s why Sunnyside Med doesn’t simply prescribe compounded naltrexone and send you on your way.

Every member completes a medical intake, and a licensed healthcare provider reviews your health history, current medications, and treatment goals before determining whether compounded naltrexone is appropriate. If there are potential interactions or medical concerns, they’re addressed before treatment begins.

And medication is only one part of the program. Sunnyside Med combines provider-guided treatment with:

• Daily reminders: Get daily nudges to stay up to date with your medication, with personalized reminders about goals and progress.
• Coaching: Text with a real human coach when you need extra support, 7 days a week. Our peer coaches have been on the journey, too.
• Community: Give and get support in the vibrant Sunnyside community, a place to cultivate a positive mindset every day.
• Progress: Whether it’s sleep, dry days, or drinks cut, Sunnyside shows you your progress in the terms that matter most to you.
• Resources: Access videos, exercises, and readings to help you get the most out of your medication and ingrain new habits over time.
• Drink tracking: Track your drinks and dry days via text message or in the app to get real-time feedback about where you are relative to your goals.

“For the first time in years, I’ve been waking up clear-headed and feeling good,” said one Sunnyside Med member. “I don’t miss feeling like I have to drink.”

If you’re wondering whether naltrexone is right for you—or why it doesn’t seem to be working yet—take our two-minute quiz to see whether you may be eligible for Sunnyside Med.

Naltrexone is a prescription medication. This content is educational and should not be taken as medical advice. A licensed clinician reviews every Sunnyside Med application.

Frequently Asked Questions (FAQ): Naltrexone interactions

Can I take naltrexone with antidepressants?

Usually, yes. There are no well-established drug interactions between naltrexone and the most commonly prescribed SSRIs or SNRIs. Your healthcare provider should still review your medication list before starting treatment.

What happens if I take opioids while taking naltrexone?

Naltrexone blocks opioid receptors, so opioid pain medications may not work as expected. If you’re physically dependent on opioids, taking naltrexone can trigger sudden withdrawal symptoms. Always tell healthcare providers you’re taking naltrexone before any surgery or new prescription.

Can I take ibuprofen with naltrexone?

Generally, yes. Ibuprofen doesn’t have a known drug interaction with naltrexone and is commonly used together when taken as directed.

Can I take Tylenol with naltrexone?

Usually, yes. There isn’t a direct interaction, but because both acetaminophen and naltrexone involve the liver, people with liver disease or those taking frequent high doses of acetaminophen should talk with their healthcare provider first.

Can I still drink alcohol while taking naltrexone?

Yes. Unlike disulfiram (Antabuse), naltrexone doesn’t make you sick if you drink alcohol.

Instead, it works by blocking some of alcohol’s rewarding effects, which may make it easier for some people to drink less over time. That’s one reason it’s commonly prescribed for people whose goal is moderation rather than immediate abstinence.

What should I tell my healthcare provider before starting naltrexone?

Share your complete medication list, including prescription medications, over-the-counter products, vitamins, herbal supplements, cannabis use, and any opioid medications you’ve taken recently. The more information your provider has, the safer and more effective your treatment plan can be.

Sunnyside Is the Perfect Companion for Your Mindful Drinking Journey

Sunnyside is the #1 mindful drinking app. Since 2020, we’ve been honing our harm-reduction approach and have helped over 400,000 people cut out 22 million drinks from their baseline habits. 96.7% of our members report success in drinking less, and in a third-party study, our approach was demonstrated to reduce weekly drinking by 33% after 12 weeks. 

Think of Sunnyside as the front door for anyone who wants to change their relationship with alcohol. If you want to drink less, we can help you get there. If you want to eventually quit, but want to take a gradual approach, we can make that happen.

When you sign up for Sunnyside, you’ll take a quick quiz, then hop into the app. It’s as simple and quick as that. 

We’ll give you weekly plans to gradually reach your drinking goals, and we’ll provide nudges, coaching, exercises, and advice to help you get there. 

We have daily tracking and journaling tools, including the option to chat with a real human coach at any time. And our state-of-the-art analytics help you track your progress over time. 

Sunnyside is a full-featured mindful drinking app. Naltrexone will actively help you reduce cravings around alcohol, and Sunnyside will help you understand your triggers and patterns, giving you a healthy system for habit change. 

If you choose to stop taking naltrexone, the Sunnyside app remains a tool you can keep using to maintain your healthy habits. 

Everyone who signs up for Sunnyside gets a free 15-day trial. After that, the subscription is $8.25/month.

Whether you’re currently taking naltrexone or just doing some research on alcohol moderation, we’d love to have you sign up for our 15-day free trial today.