Naltrexone Alternatives. Over The Counter Availability

Last Updated: June 24, 2020

Authored by Olivier George, Ph.D.

Reviewed by Michael Espelin APRN

There are several naltrexone alternatives that are used to treat alcohol dependence and opioid addiction. Just like naltrexone (Vivitrol), most of these alternatives are also not sold over the counter. However, prescription of any of these naltrexone alternatives depends on factors like patient motivation, treatment goals, and medical comorbidities.

Naltrexone Alternatives

Naltrexone alternative medication can be prescribed because of reasons like treatment goals, the patient’s side effects, effects on reproductive health, and medication tolerability to the drug.

Furthermore, since an over the counter naltrexone drug is not available to patients, all these factors have to be weighed by a medical professional. Here are alternative drugs that can be prescribed in place of Vivitrol.


Suboxone, also called buprenorphine/naloxone, is a naltrexone alternative that is similarly used to treat opioid addiction and dependence. Its main dosage forms are pills, dissolving tablets, and sublingual film, unlike naltrexone which is available in injectable and oral formulations. However, just like naltrexone, which lacks over the counter drugs, suboxone also does not have OTC alternative drugs and is prescription only.

Advantages Disadvantages
Best suited to treat heroin dependence and addiction. Not suited for people with long-acting opioids because of the risk of a long withdrawal.
Has fewer drug interactions and side effects as compared to other similar drugs. Can cause slowed breathing, coma or even death when overdosed or mixed with other depressants.
The dosage can be adjusted to an amount that is best suited for the patient. The sublingual film can cause burning mouth syndrome.


Marketed under the brand name Campral, Acamprosate works by restoring the disrupted changes in neurobiology as a result of alcohol intake. This naltrexone alternative should not be mixed with alcohol since it does not work well when the patient is still drinking.

Advantages Disadvantages
Patients who are on it do not develop tolerance or dependence on it. May lead to suicidal ideation, although this side effect is less common.
There is almost zero overdose risk associated with it. Causes diarrhea as a more common side effect.
Most side effects tend to be mild and tend to disappear within the first weeks of treatment; however, diarrhea is persistent for longer.


It’s an effective treatment for drug dependence or severe pain. However, just like patients cannot buy naltrexone over the counter, Methadone is also available by prescription only.

Advantages Disadvantages
Can also be used to treat opioid dependence as a complete recovery program just like other naltrexone alternatives. If mixed with alcohol, sleeping pills, or muscle relaxants, the drug can cause severe side effects such as coma, slowed breathing, and even death.
Available as a cheaper generic version. Often, it may cause constipation.
It is not the best option for short-term pain relief.


The use of Antabuse is limited to alcohol addiction treatment. Especially, the studies indicate that disulfiram is more effective at promoting alcohol abstinence. However, it poses several risks, including liver damage, which are similar to Vivitrol shot side effects.

Advantages Disadvantages
It has proven to be successful with supervised and compliant patients. It may cause hepatitis; however, the risk is usually low.
It does not affect the brain receptors directly. It is only effective for treating alcohol use disorder and can have adverse effects if taken while still using alcohol.


Narcan (naloxone) is used to quickly reverse the effects of an opioid overdose such as heroin and morphine. This is the major difference between naloxone and naltrexone.

Advantages Disadvantages
Can be administered easily with the availability of a prepackaged nasal spray, auto-injectable device, and injectable dosage forms. Can cause acute withdrawal symptoms if the person has been using opioids regularly.
Suitable in cases of emergency opioids overdose. May require repeat dosing in cases where opioids hang around the body for a long time.

Naltrexone Over The Counter Alternatives

Naltrexone OTC drug alternatives are not available as they are prescription only medications. This means that the only way that someone can obtain the drug is by a doctor’s prescription. This also goes for the majority of other naltrexone alternatives as well. Therefore, despite Vivitrol is not addictive, there is no any OTC alternative medication to the drug.

However, there are several natural substitutions which help to manage alcohol and opiate craving, though less effective:

  • D-Phenylalanine (DL-Phenylalanine). It has an anti-craving effect, helping to cope with depressive mood. This supplement provides mild improved energy and focus, as well as promotes pain relief.
  • L-Phenylalanine (L-Tyrosine). It acts as a stimulator improving the mental focus and providing an energy increase.
  • Cayenne Pepper. It helps not only with alcohol craving but some other symptoms such as irritability and anxiety, which accompany the detox process. Also, it assists in suppressing tremors, nausea; several other side effects which precede and alarm relapse.
  • Grain Diet. Grains are full of carbohydrates and fiber, which are core elements for a quick energy boost and enhanced recovery.

naltrexone over the counter alternatives

Medication-Free Alternative Remedies

Alcohol and opioids addiction may cause health complications in addition to the adverse reaction that may result in, for example, using opiates while on Vivitrol and other medication. Apart from medication, there are also exists other non-medication remedies that may be used. Some of them are:

  • Focus on proper nutritional support through a good diet plan that may include vitamin supplements.
  • Stay hydrated to maintain the proper functioning of body systems, including heart, brain, kidneys, and liver. It’s critical as excessive sweating and diarrhea that accompany opiate withdrawal may cause dehydration.
  • Hydrotherapy which involves the use of water for soothing pains and leveling certain side effects.
  • Use natural sleep supplements such as melatonin, valerian root, and chamomile can help cope with occasional insomnia.

Considering Alternatives

Naltrexone alternatives include drugs such as Narcan, Antabuse, Methadone, Acamprosate, and Suboxone. All of them have their downsides and advantages and are only by prescription drugs. Any drug abuse signs should be treated as soon as possible. The medical staff in the addiction centers with their treatment programs is among the best options for those with opioid addiction.

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Published on: June 7th, 2019

Updated on: June 24th, 2020

About Author

Olivier George, Ph.D.

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.


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