Opioid Antagonists/Opioid Analgesics Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Very Serious. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, the opioid antagonist may decrease the effects of the opioid analgesic.

What might happen:

You may experience withdrawal symptoms from your opioid analgesic while taking an opioid antagonist.

What you should do about this interaction:

Contact your healthcare professionals (e.g. doctor or pharmacist) as soon as possible about taking these two medicines together. They may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Revia (naltrexone) US prescribing information. Duramed Pharmaceuticals, Inc. October, 2013.
  • 2.Selincro (nalmefene hydrochloride dihydrate) UK prescribing information. Lundbeck Limited February, 2019.
  • 3.Lybalvi (olanzapine-samidorphan) US prescribing information. Alkermes, Inc. January, 2024.
  • 4.Vivitrol (naltrexone for extended-release injectable suspension) US prescribing information. Aklermes, Inc. March, 2021.
  • 5.Abboud TK, Lee K, Zhu J, Reyes A, Afrasiabi A, Mantilla M, Steffens Z, Chai M. Prophylactic oral naltrexone with intrathecal morphine for cesarean section: effects on adverse reactions and analgesia. Anesth Analg 1990 Oct;71(4):367-70.
  • 6.Stoops WW, Lofwall MR, Nuzzo PA, Craig LB, Siegel AJ, Walsh SL. Pharmacodynamic profile of tramadol in humans: influence of naltrexone pretreatment. Psychopharmacology (Berl) 2012 Oct;223(4):427-38.
  • 7.Volavka J, Resnick RB. Letter: Treatment of accidental naltrexone-induced withdrawal. Am J Psychiatry 1976 Feb;133(2):233.
  • 8.Loitman JE. Enhanced analgesia with opioid antagonist administration. J Palliat Med 2006 Dec;9(6):1250-3.
  • 9.Farahmand S, Ahmadi O, Dehpour A, Khashayar P. Does adding low doses of oral naltrexone to morphine alter the subsequent opioid requirements and side effects in trauma patients?. Am J Emerg Med 2012 Jan;30(1):75-8.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.