Can You Take Naltrexone With Suboxone?

Ever heard of the saying “the more the merrier”? While this may be true for laughter and love, the same can’t be said for naltrexone and Suboxone. Naltrexone and Suboxone are two common medications used to treat substance use disorders and can commonly be mistaken as one and the same.

Recovering from substance dependence is no cakewalk, and unpleasant withdrawal symptoms may have us wondering if taking both naltrexone and Suboxone can help. This strategy may have worked that time we needed an extra Tylenol for that unusually unbearable headache, but with naltrexone and Suboxone, double dipping can cause detrimental effects.

For those of us who are recovering from substance dependence, it’s worth exploring all possible solutions to help us reach our end goal. Having better knowledge of what naltrexone and Suboxone are and how they work helps us understand why they don’t go hand-in-hand. Let’s get into some alternative strategies for how to navigate substance use recovery, but first, let’s understand more about the combination of naltrexone and Suboxone to help cross it off the list for possible solutions. 

What Is Naltrexone?

Naltrexone is a type of drug known as an opioid antagonist, meaning it blocks the action of opioids. It’s approved by the Food and Drug Administration (FDA) as a medication to treat alcohol use disorder (AUD) and opioid use disorder (OUD). Naltrexone works by blocking opioid receptors in our brain — effectively getting rid of the intoxication effects of alcohol and opioids. It takes control of the brain’s reward system, erasing the shininess from substances that have us wanting more and more.

Let’s think of our favorite food. If all of a sudden, it didn’t taste good to us anymore, we probably wouldn’t want to eat it again. Naltrexone works in this way, blocking the positive feelings we previously associated with drinking alcohol — helping to eliminate dependence. 

The medication comes in two different forms. Both the pill form and the extended-release injectable (Vivitrol) are typically prescribed as just one component of an extensive treatment plan for substance use disorders. The pill is less common; it’s prescribed and taken at home. The injectable is administered by a clinician and is a common part of outpatient treatment programs.

Naltrexone has been a staple of recovery programs since the 1980s. In 2002, a new player entered the market: Suboxone. How are naltrexone and Suboxone different? To understand that, let’s get a clearer picture of what Suboxone is.

What Is Suboxone?

Suboxone is a medication composed of a combination of two drugs — buprenorphine and naloxone. The four-to-one ratio of buprenorphine and naloxone make up Suboxone, an FDA-approved medication primarily used to treat OUD. The combination of the two drugs gives Suboxone its unique action mechanism that decreases substance dependence. 

Buprenorphine is categorized as an opioid partial agonist, meaning it has some opiate properties. This means that it stimulates similar feelings produced by opioids at a much lower dose. Naloxone (the generic name for Narcan) is a strong opioid antagonist, just like naltrexone. It prevents the activation of opioid receptors, blocking the rewarding part of our reward system. In combination, these drugs are effective in treating OUD by reducing cravings and withdrawal symptoms at the same time. 

Naltrexone and Suboxone can be likened to the difference between Tylenol and Advil, two different medications used to treat similar symptoms. Despite their differences, the two are often associated. Let’s take a closer look at why this is.

The Links Between Naltrexone and Suboxone

To understand why naltrexone and Suboxone are frequently associated with one another, let’s take a look at three big ways they’re linked. 

1. Substance use disorder. Naltrexone and Suboxone are both at the top of the list of medications used to treat substance use disorders, especially opioid use. While their mechanisms differ, both medications are effective treatments for decreasing substance dependency, and they are often spoken of as a single unit.
2. Multiple dependencies. Another potential connection comes from those of us recovering from multiple dependencies. Our treatment plan may involve targeting one substance first, then tackling another — and this may involve a switch from one medication to the other. Therefore, we may conclude that combining the two medications could be a more thorough approach to knock everything out at once. Unfortunately, it doesn’t work that way. (We’ll explore this more in the next section.)
3. Multi-medication treatment plans. We may know others who have been treated with both Suboxone and naltrexone at different points in their recovery. Suboxone is usually the first line of treatment for opioid withdrawal. Naltrexone is sometimes prescribed after Suboxone as the next step, or it may be prescribed first. Switching from Suboxone to naltrexone requires a detox period. This will be carefully overseen by a clinician and isn’t something we can guesstimate on our own.

Clearly, these two medications are associated for a reason. But the truth is, they’re quite different.

Main Differences Between Suboxone and Naltrexone

Naltrexone and Suboxone are both FDA-approved medications, but their distinguishable differences help us determine whether or not they can be used in conjunction. The three differences between Suboxone and naltrexone are based on these main aspects:

• Classification. Suboxone is a partial opioid agonist and opioid antagonist, as it combines two different types of drugs. On the other hand, naltrexone contains only opioid antagonist properties. 
• Mechanism. Since the components of the medication differ, the way in which they work also differs. Naltrexone works as an opioid blocker, and Suboxone triggers and blocks at the same time. 
• Application. Naltrexone is FDA-approved to treat alcohol and opioid use disorder, whereas Suboxone is only approved to treat opioid use disorder. The partial opioid agonist part of Suboxone can cause serious side effects when mixed with the depressive properties of alcohol.

We’ve acknowledged the distinct differences between naltrexone and Suboxone, but let’s dive further to see if they can be used together. 

Can You Take Naltrexone With Suboxone?

To put it bluntly — no. Naltrexone and Suboxone should not be taken together in any situation.

The two drugs have interactions that cancel out their effects. Naltrexone is an opioid antagonist that attaches to receptors in our brain and blocks intoxicating effects. Since buprenorphine, the main component of Suboxone, is a partial opioid agonist, naltrexone will not allow it to attach — making the entire mechanism of Suboxone ineffective.

Think of a plug and socket. Naltrexone is the plastic cover that covers the socket to keep it protected. Suboxone is the plug that goes into the socket. There’s no way to plug both in at the same time, just like naltrexone and Suboxone can’t be used together.

Not only do they block each other’s effects, but naltrexone and Suboxone if used together cause some potentially harmful results.

Negative Effects of Taking Naltrexone and Suboxone Together 

Side effects are a part of all medications, but the mix of naltrexone and Suboxone causes additional complications. One of the main consequences of taking naltrexone and Suboxone together is the occurrence of precipitated withdrawal.

Precipitated withdrawal is the immediate and severe onset of withdrawal symptoms. Let’s go back to our plug-and-socket analogy. If we were to force the plastic cover (naltrexone) and the plug (Suboxone) into the socket at the same time, it would break and potentially cause a shock — just the way the mixed signals in our brain can cause precipitated withdrawal. Precipitated withdrawal involves potentially dangerous manifestations that are not limited to these symptoms:

• Depression
• Suicidal thoughts
• Increased heart rate
• High blood pressure
• Fever
• Sleep disruptions
• Sweating

Naltrexone and Suboxone each have individual side effects that should be taken into account. Taking the two medications together can not only cause a sudden onset of withdrawal, but it can also compound secondary repercussions. We are at risk of experiencing a greater number of common side effects that may involve the following:

• Cold symptoms
• Dizziness 
• Fatigue 
• Restlessness
• Loss of appetite 
• Headache 
• Sweating 
• Fever 
• Muscle ache

While taking naltrexone and Suboxone together isn’t an option, let’s explore some ways that we can navigate recovery to make the journey less brutal.

Navigating Alcohol Use Disorder Recovery and Withdrawal

Recovery from AUD is no picnic in the park, but we can utilize strategies to make it easier. Let’s delve into some ways to better navigate recovery and withdrawal.

Alcohol Withdrawal Syndrome (AWS) 

Withdrawal symptoms are a common but unpleasant experience in recovery. Alleviating unpleasant withdrawal symptoms is a significant aspect of preventing relapse. Serious withdrawal symptoms of AWS such as delirium tremens require medical attention and can be life-threatening to bear alone. We can manage less severe experiences of withdrawal by taking the following steps:

• Practice self-care. Stay hydrated, eat balanced meals, and participate in activities that you enjoy. Take care of yourself as you would a loved one!
• Get some exercise. It may feel like the last thing you want to do when going through withdrawal, but light activity gets our blood flowing and energy going, and it also has positive effects on mood.
• Avoid triggers. Common triggers include alcohol-centric celebrations or social environments that pressure us to drink. Identifying and avoiding personal triggers also helps reduce thoughts of drinking.
• Resetting the nervous system. Our sympathetic nervous system is our fight-or-flight response. Actions such as taking a cold shower, taking deep breaths, or using EFT tapping can reset the nervous system and help reduce sudden urges to drink. 
• Seeking support. Help from professionals or reinforcement from loved ones can help us navigate tough experiences. Online tools such as the Reframe app provide helpful resources and support we can use to motivate us on our recovery journey.

Moving Forward

It can be challenging to move forward and away from the limited world of drinking after living with alcohol dependence. Thankfully, there is so much more to life! We can start thriving by focusing our energy toward the following positive practices:

• Explore hobbies and interests. Find activities that you enjoy and divert your energy into positive pursuits. Pick up a new sport or revisit prior passions that took a backseat to alcohol during our dependence phase. 
• Develop new social connections. It’s common to feel like we’ve lost old connections by leaving our social drinking circle. However, developing positive relationships with sober friends helps us build a new circle of support aligned with our current lifestyle. 
• Manage stress. Develop positive coping strategies and implement mindfulness practices to stay grounded when things get tough. Journaling, meditation, and yoga are some great activities to reduce stress.
• Prioritize healthy living. Eating well, avoiding negative influences, and setting goals are all ways that we can live a healthier and more fulfilling life. 

Bringing It Back Together

Naltrexone and Suboxone are often discussed in the same breath (their names are even similar!), but they are incredibly different. While both are used to treat substance misuse, they differ greatly in the way they work. It’s important to be aware of the impacts of mixing the two to prevent dangerous consequences. We’re commonly looking for ways to add to our life. But, the combination of naltrexone and Suboxone is one we want to divide!