Encyclopedia · Medications, named

Naltrexone in the UK — plain guide

Naltrexone is the most widely-evidenced drug for alcohol problems that almost nobody in the UK has heard of. It is not a magic pill, and the people who say it is have usually not tried it. It is, however, a quiet, unglamorous, well-evidenced tool, and it is harder to get hold of than it should be. This is the version I wish someone had handed me in 2019.

What naltrexone actually does

It is an opioid receptor antagonist. In English: it sits on the receptors that alcohol normally rewards and quietly takes the shine off a drink. Over weeks, the brain notices that drinking is not paying out. The compulsion gets quieter. For some people it goes. For others it dims to a manageable hum.

It does not stop you drinking. It does not make you sick if you drink. It does not sedate you. You will not feel the first dose. That is not the drug failing. That is how it works.

Two ways to take it

Daily, for abstinence

One 50mg tablet a day, every day, alongside not drinking. Reduces the urge to start again. Most useful for the person who has stopped and is white-knuckling the first six months.

The Sinclair Method, for cutting down

One 50mg tablet, one hour before any drink. Every time you drink. Never on a day you are not drinking. Over six to twelve months, the link between alcohol and reward erodes. People drink less, and many stop. The C Three Foundation is the lay reference. Roy Eskapa’s The Cure for Alcoholism is the book most prescribers in this country have not read but should.

How to actually get it in the UK

NHS

It is NICE-recommended for alcohol dependence. In practice, your GP will probably refer you to the local community alcohol service rather than prescribe it directly. Ask. If you get a flat no, ask for the local pathway in writing. Persistent and polite gets further than angry.

Private

If you cannot get it on the NHS or you cannot wait, several UK telehealth providers prescribe it. Expect somewhere between forty and ninety pounds a month all-in by 2026 prices. Check the prescriber is GMC-registered. Check the pharmacy is GPhC-registered. The encyclopedia has a small named list of providers I have personally checked.

What to ask for at the appointment

• 50mg naltrexone, three months’ supply to start.
• Liver function blood test before starting, again at three months. Routine. Not optional.
• Whether you are taking it daily or on the Sinclair Method, and the prescriber understands the difference. Some still don’t.
• What to do if you are also on opioids for pain. This matters and is not a footnote.

Side effects, plainly

Most people get nausea or a headache for the first week or two. A small number get a flat affect — the bottom of the good days as well as the bad ones — which usually settles. A very small number cannot tolerate it at all. Liver issues are rare but real, which is why the blood tests exist.

You cannot drink heavily on naltrexone for years and ignore your liver. The drug is not the issue. The drinking is.

What it does not do

• It does not replace therapy, fellowship, or honest conversation with the people in your life.
• It does not work without the doses. People stop taking it because the urge has gone, the urge comes back, and they blame the drug.
• It does not work for everyone. Roughly two thirds of people who take it correctly get a meaningful response. The other third do not. Acamprosate or disulfiram is the next conversation.

What I would tell my own brother

Get the prescription. Take it on the days you would have drunk. Notice that the third drink is no longer interesting. Tell one person you trust that you are doing it. Give it three months before you have an opinion.

Naltrexone is not the centre of recovery. It is the thing that makes the centre easier to build. The fellowship-or-equivalent, the honest human, the work — those are the centre. The drug is the scaffolding while you put them in.

Written by James. Sober since June 2020. Not a clinician, not a therapist, not a sponsor. The patient who paid the fee, did the work, and lived the years that followed. Last reviewed April 2026. Nothing here is medical advice. Talk to your GP about anything that involves your body.