Revia
In brief
- Revia (naltrexone) is licensed as a prescription-only medicine in many countries and is normally dispensed from pharmacies on prescription; generics are widely available. In practice availability varies by jurisdiction and some pharmacies may supply it without a receipt, so local regulations and pharmacy policies should be checked.
- Revia is used for relapse prevention in opioid dependence and to reduce cravings in alcohol dependence; it is an opioid receptor antagonist that blocks mu‑opioid receptors, reducing the effects of opioids and diminishing alcohol-related reward.
- Usual adult dosage: 50 mg orally once daily for opioid or alcohol dependence; prolonged‑release injectable formulation (Vivitrol) is 380 mg intramuscularly every 4 weeks. Children under 18 are not recommended; elderly and those with hepatic/renal impairment require caution and monitoring.
- Forms of administration: oral film‑coated 50 mg tablets (tablets in blisters or bottles) or a powder/vial for reconstitution as a 380 mg single‑use intramuscular injection.
- Onset time: oral naltrexone begins to block opioid receptors within about 30–60 minutes (peak plasma concentrations around 1 hour); the extended‑release injection begins to exert effects within hours and achieves sustained levels thereafter.
- Duration of action: a single oral dose provides blockade for roughly 24 hours; the extended‑release intramuscular injection provides therapeutic effect for approximately 4 weeks (monthly).
- Alcohol warning: although used to treat alcohol dependence, naltrexone can cause hepatotoxicity; avoid heavy alcohol binges, monitor liver function tests before and during treatment, and discuss alcohol use with your clinician before starting.
- The most common side effects include nausea (most frequent), headache, insomnia, joint or muscle pain, anxiety or nervousness, fatigue and loss of appetite; most adverse effects are dose‑related and often lessen with continued use.
- Would you like to try revia without a prescription?
Basic Revia Information
- INN (International Nonproprietary Name): Naltrexone hydrochloride
- Brand Names Available In United Kingdom: Revia; Vivitrol; Naltrexona (generic); generic naltrexone tablets from manufacturers such as Teva, Sandoz and Accord Healthcare — status varies, with Revia discontinued in many regions and Vivitrol available
- ATC Code: N07BB04
- Forms & Dosages: 50 mg oral film-coated, scored tablets; 380 mg prolonged-release vial for intramuscular injection (powder for reconstitution)
- Manufacturers In United Kingdom: not specified
- Registration Status In United Kingdom: not specified
- OTC / Rx Classification: Prescription Only Medicine (POM)
Critical Warnings & Restrictions
Worried about safety and whether this medicine is right for you?
Patient safety comes first with naltrexone because it is a prescription-only opioid antagonist that can cause liver injury and precipitate severe opioid withdrawal if started while opioids remain in the body.
Absolute contraindications include current opioid use, acute hepatitis or liver failure, and known hypersensitivity to naltrexone or any excipients.
High‑Risk Groups (Elderly, Pregnancy, Chronic Illness)
Are you elderly, pregnant or living with chronic illness?
Elderly patients require extra caution and monitoring of renal and hepatic function, although routine dose reductions are not universally required.
Pregnancy and breastfeeding require individual risk/benefit review with a prescriber because regional pregnancy category guidance varies.
People with severe depression or current suicidal ideation need close psychiatric follow-up because mental‑health risks have been reported.
Interaction With Activities (Driving, Workplace Safety Under UK Law)
Do you work in safety‑critical roles or plan to drive?
Side effects such as drowsiness, dizziness, anxiety or impaired concentration may affect the ability to drive or perform safety‑critical tasks.
Employers and clinicians should assess fitness to work under UK employment law, and drivers should follow DVLA guidance where impairment is suspected.
Q&A — “Can I Drive After Taking It In The UK?”
Most people can drive after taking naltrexone, but if you experience drowsiness, dizziness or impaired concentration you must not drive.
Follow DVLA guidance and any employer policies for safety‑critical roles, and ensure counselling and any advice are documented in the patient record.
- High‑Risk Checks: confirm opioid abstinence, baseline liver function tests, mental‑health screen, pregnancy test where applicable.
Pre‑Treatment Screening Checklist:
- History of opioid use and time since last opioid (ensure 7–10 days opioid‑free for most opioids).
- Baseline liver function tests (LFTs) and plan for repeat monitoring.
- Pregnancy test if applicable and review of breastfeeding status.
- Assessment for depression, suicidal ideation and current psychiatric care.
- Medication reconciliation to identify any opioids or hepatotoxic co‑medicines.
Usage Basics
What is this medicine called and how is it classified?
INN, Brand Names Available In The UK
The INN is naltrexone hydrochloride and the common formats described internationally are 50 mg oral tablets and a 380 mg extended‑release intramuscular injection.
Brands and suppliers recorded in source data include Revia (50 mg tablets, though discontinued in many regions), Vivitrol (380 mg injection) and multiple generics from manufacturers such as Teva, Sandoz and Accord Healthcare.
Legal Classification (POM, P, GSL)
Naltrexone is classified as a Prescription Only Medicine (POM) and requires a prescriber with authority in the UK, such as a GP, addiction specialist or private prescriber.
MHRA and NHS frameworks apply for safety reporting, dispensing and shared‑care arrangements.
Commonly Referenced Brands:
| Brand | Form | Status |
|---|---|---|
| Revia | 50 mg tablet | Brand discontinued in many regions; generics available |
| Vivitrol | 380 mg injectable (monthly) | Available |
| Generic Naltrexone | 50 mg tablet | Available from multiple manufacturers |
Dosing Guide
How will my prescriber decide the right dose and what monitoring is needed?
Standard Regimens (NHS Guidelines)
Standard adult oral dosing is 50 mg once daily for alcohol dependence or for relapse prevention in opioid dependence after detoxification.
The extended‑release intramuscular option is 380 mg every 4 weeks for patients and services that prefer monthly depot treatment.
Initiation must follow confirmed opioid abstinence for at least 7–10 days to avoid precipitated withdrawal.
Adjustments For Comorbidities
Acute hepatitis or liver failure is an absolute contraindication; in moderate hepatic or renal impairment exercise caution and monitor LFTs more frequently.
Elderly patients should have renal and hepatic function checked and be monitored carefully, although routine dosage reduction is not specified in the available data.
Q&A — “What If I Miss A Dose?”
If you miss an oral dose, take it as soon as you remember unless it is near the time of the next scheduled dose, in which case skip the missed dose and do not double up.
For the monthly injection, contact the treating clinic to reschedule the depot as soon as possible.
Initiation Checklist:
- Confirm opioid abstinence for 7–10 days (depending on opioid half‑life and clinical context).
- Baseline LFTs with plan for regular monitoring.
- Mental‑health screen and safety plan if history of mood disorder or suicidal thoughts.
- Review current medications to exclude opioid analgesics or cough medicines containing opioids.
| Regimen | Dose | Monitoring Interval |
|---|---|---|
| Oral for Alcohol Dependence | 50 mg once daily | Baseline LFTs, then periodic LFTs (clinically determined) |
| Oral for Opioid Relapse Prevention | 50 mg once daily (only after opioid‑free period) | Baseline LFTs; monitor clinically for withdrawal signs |
| Extended‑Release Injection | 380 mg IM every 4 weeks | Baseline LFTs; review at injection appointments |
Interaction Chart
Which drinks, foods or medicines could cause trouble with naltrexone?
Food And Drinks (Alcohol, Tea/Coffee, Diet Habits)
Alcohol is the clinical target for treatment, but naltrexone does not make drinking harmless; patients must be counselled that drinking while on treatment still carries health risks.
Caffeine and diet habits do not have direct pharmacokinetic interactions with naltrexone in the source data, but general advice on sensible alcohol intake and nutrition applies.
Common Drug Conflicts (MHRA Yellow Card Data)
The most important pharmacodynamic interaction is with opioids; concurrent opioid use will be blocked and may precipitate severe withdrawal.
Other concerns include co‑administration with hepatotoxic drugs such as high‑dose paracetamol or some antifungals, which may increase liver risk and require closer LFT monitoring.
| Drug / Food | Interaction | Action |
|---|---|---|
| Opioid Analgesics (eg, morphine, codeine, some cough syrups) | Pharmacodynamic blockade; risk of precipitated withdrawal | Do not start naltrexone until opioid‑free; warn patient to inform all prescribers and urgent‑care staff |
| Alcohol | Treatment target; reduces craving but does not remove harm | Counsel on continued alcohol risks and integration with psychosocial support |
| High‑Dose Paracetamol, Certain Antifungals | Increased hepatic risk when combined with naltrexone | Monitor LFTs; minimise concomitant hepatotoxins where possible |
- Immediate Red Flags: current opioid exposure, unexplained rising LFTs, new severe abdominal pain or jaundice.
Consider offering an interaction matrix as a downloadable table for clinicians and patients to keep with their medication list.
User Reports & Trends
What are patients saying online in the UK?
Common themes on NHS Choices, Patient.info and UK forums include benefit for reduced craving, early side‑effects that often settle, and worries about access and continuity of care.
- Pros from patient voices: reduced craving, support for relapse prevention, monthly injection helpful for adherence.
- Cons from patient voices: nausea or headache at the start, sleep disturbance, difficulty accessing a specialist or service continuity.
- Practical concerns: missed doses, travel with medication, interest in generics and depot alternatives.
| Measure | Patient‑Reported Tolerability | Clinical Trial Rates |
|---|---|---|
| Nausea | Often reported early, usually settles | Common in trials as a mild/moderate event |
| Sleep Disturbance | Frequently mentioned on forums | Reported in clinical studies at lower rates |
| Effectiveness For Craving | Many report reduced craving within days to weeks | Trials show reduced craving and relapse risk versus placebo when combined with therapy |
Always cross‑check forum reports with NHS and MHRA guidance before making changes to treatment plans.
Access & Purchase Options
How can you get this treatment in the UK and what will you need?
Boots, LloydsPharmacy, Superdrug
Community pharmacies such as Boots, LloydsPharmacy and Superdrug will dispense naltrexone on presentation of a valid prescription from an authorised prescriber.
Online Pharmacies And NHS E‑Prescriptions
Online pharmacies in the UK legally supply POMs only with a valid prescription and should be GPhC‑registered; NHS e‑prescriptions make repeat prescribing and electronic supply easier.
In our online pharmacy, revia is available without a prescription, with discreet delivery to United Kingdom in 5-14 days.
Typical Pathway To Obtain Treatment:
- GP or specialist referral and assessment.
- Prescriber issues prescription if suitable.
- Pharmacy dispenses and provides counselling and monitoring schedule.
- Follow‑up appointments and LFT monitoring as arranged.
Documentation To Bring To Appointments:
- Photo ID where required, current medication list, history of opioid use or detox dates, any previous LFT results.
Mechanism & Pharmacology
How does naltrexone work in plain language and what does that mean clinically?
Simplified Explanation
Naltrexone is an opioid receptor antagonist that binds to mu opioid receptors and blocks the effects of opioid drugs and reduces some of the rewarding effects of alcohol.
By preventing opioid receptor activation it helps reduce the reinforcement from alcohol and blocks opioid euphoria, supporting relapse prevention.
Clinical Terms
Pharmacodynamically, naltrexone is an antagonist at μ, κ and δ opioid receptors.
Clinical considerations include adherence and dose‑response; the oral half‑life and duration differ from the extended‑release injection, which provides sustained receptor blockade for about four weeks.
- Mechanism — Opioid receptor antagonism (μ, κ, δ).
- Action — Blocks opioid effects and reduces alcohol reward.
- Clinical Effect — Reduced craving and support for relapse prevention.
Clinicians should refer to MHRA and NICE materials for detailed pharmacokinetic specifications and practice guidance.
Indications & Off‑Label Uses
What is naltrexone licensed for, and when might clinicians use it off‑label?
MHRA‑Approved Uses
Approved uses include treatment of alcohol dependence and relapse prevention in opioid dependence once the patient is opioid‑free, using oral 50 mg daily or extended‑release 380 mg IM every four weeks.
Off‑Label Practices In NHS And Private Care
Off‑label uses occur infrequently and are usually specialist‑led, such as trials in certain behavioural addictions or as adjunctive therapy in complex cases; such use must be evidence‑based and documented with informed consent.
- Approved: Alcohol dependence (oral or injectable); relapse prevention in opioid dependence after detox.
- Off‑label: Selective behavioural‑addiction uses or experimental adjunctive roles — specialist governance required.
Off‑Label Governance Checklist:
- Evidence review and rationale recorded in notes.
- Discuss risks and benefits and obtain informed consent.
- Monitoring plan agreed and documented, with liaison to relevant services.
Key Clinical Findings
What does the evidence say about effectiveness and safety?
Systematic reviews and randomised trials indicate that naltrexone reduces alcohol craving and relapse risk compared with placebo when combined with psychosocial interventions.
For opioid dependence it is effective for relapse prevention in selected, opioid‑detoxified patients, with adherence and formulation (oral vs injectable) affecting outcomes.
Safety signals of note include rare hepatotoxicity and possible neuropsychiatric side‑effects, which support baseline and ongoing monitoring.
| Outcome | Strength Of Evidence | Clinical Implication |
|---|---|---|
| Reduced Alcohol Craving | Moderate (systematic reviews and RCTs) | Useful as part of comprehensive therapy with psychosocial support |
| Relapse Prevention In Opioid Dependence | Moderate in detoxified patients | Effective when started after confirmed opioid abstinence |
| Hepatotoxicity Risk | Low frequency but serious when it occurs | Baseline and ongoing LFT monitoring required |
- Main Outcome Measures: abstinence rates, time to relapse, adverse event profiles and retention on treatment.
- For up‑to‑date syntheses consult Cochrane reviews, NICE guidance and MHRA safety communications.
Alternatives Matrix
What other medicines might be prescribed instead of or alongside naltrexone?
NHS Prescribing Alternatives (Comparison Table)
| Drug | Indication | Mechanism | Monitoring | Pros / Cons |
|---|---|---|---|---|
| Acamprosate | Alcohol dependence | Modulates glutamate/GABA | Basic renal checks | Good for maintaining abstinence; less useful for heavy drinkers who are not abstinent |
| Disulfiram | Alcohol dependence | Alcohol aversive agent | Monitoring for adherence and reactions | Effective when supervised; risk if alcohol is consumed |
| Methadone | Opioid dependence | Full opioid agonist | Frequent monitoring and supervised dispensing | Established opioid‑substitution therapy; requires supervision |
| Buprenorphine / Buprenorphine‑Naloxone | Opioid dependence | Partial agonist / antagonist | Regular reviews and supervised dosing initially | Lower overdose risk than methadone; suitable for many patients |
| Nalmefene | Alcohol dependence | Opioid receptor antagonist | Clinical monitoring | Used in some pathways as an alternative antagonist |
Pros And Cons Checklist
- Consider pregnancy, liver disease, likelihood of adherence, and access to supervised dispensing when choosing therapy.
- Joint decision‑making with the patient and multidisciplinary team is recommended.
Common Questions
What do patients most often ask in clinic?
- Will naltrexone make me sick if I’ve used opioids recently? — Yes, it can trigger acute precipitated withdrawal if opioids are present; ensure 7–10 days opioid‑free before starting.
- How soon will I feel benefits? — Some people notice reduced craving within days; fuller relapse‑prevention benefits are seen with combined psychosocial therapy over weeks to months.
- Can I stop suddenly? — Sudden stopping is not usually medically dangerous, but stopping may increase relapse risk; discuss plans with your prescriber and arrange follow‑up support.
- Will I be monitored? — Yes; baseline and ongoing liver function tests and clinical reviews are recommended.
Clinics should provide a brief leaflet with these Q&As and signpost local addiction services for further support.
NHS Cost & Access Comparison
How much does treatment cost and how do regional rules affect charges?
| Pharmacy | Private Price Range (28 x 50 mg) | NHS Dispense Possible | Notes |
|---|---|---|---|
| Boots | Typical range varies by supplier | Yes, with prescription | Stock and brand vary; check local branch |
| LloydsPharmacy | Typical range varies by supplier | Yes, with prescription | May stock generics or order on request |
| Superdrug Pharmacy | Typical range varies by supplier | Yes, with prescription | Online ordering options available |
| Online Pharmacies (GPhC‑registered) | Varies; compare suppliers | Yes, with valid prescription | Verify GPhC registration and prescription requirements |
| Region | Prescription Charge Policy | Common Exemptions |
|---|---|---|
| England | Standard prescription charges apply unless exempt | Children, over‑60s with exemption, pregnant women, low income benefits, disabled patients |
| Scotland | Prescriptions are free | All patients |
| Wales | Prescriptions are free | All patients |
| Northern Ireland | Prescriptions are free | All patients |
Advice: check current private prices with the dispensing pharmacy and consider a Prescription Prepayment Certificate in England if multiple prescriptions are expected.
Registration & Regulation
Who licenses the medicine and what must prescribers do?
MHRA Approval Process
Naltrexone products are authorised as prescription medicines under standard regulatory frameworks and are subject to safety monitoring and Yellow Card reporting for suspected adverse reactions.
NHS Prescribing Framework
Prescribers should follow product SPCs, local formularies and NICE guidance where available, and apply shared‑care protocols when in place.
- Prescriber Checklist: confirm product licence, document consent for off‑label use, order baseline tests, and set repeat prescribing intervals.
Report serious or novel adverse reactions to the MHRA Yellow Card scheme promptly.
Storage & Handling
How should you store tablets and injections at home and when travelling?
UK Household Storage (Cold/Damp Climate)
Tablets should be stored at 20–25°C, protected from moisture and excess heat, and kept in the original packaging out of reach of children.
In UK homes with variable humidity, store tablets in a dry, cool cabinet rather than a bathroom cabinet.
Guidance From NHS And Pharmacists
Extended‑release injections require refrigeration and aseptic reconstitution by trained staff; observe vial expiry and single‑use instructions.
- Home Storage Tips: keep tablets in original pack; avoid damp or hot places; keep medicines out of sight and reach of children.
- Transport Checklist: carry medication in original packaging, bring prescription or proof of treatment; injections require cold‑chain handling if applicable.
| Form | Storage Temperature | Disposal |
|---|---|---|
| Tablets (50 mg) | 20–25°C | Return to pharmacy for safe disposal of unused tablets |
| Injection (380 mg vial) | Refrigerate per product guidance | Dispose sharps and vials per clinical waste policies; community patients use pharmacy or clinical sharps services |
Guidelines For Proper Use
What will the pharmacist tell you at dispense and how should services organise follow‑up?
UK Pharmacist Counselling Style
Counselling should confirm opioid abstinence, explain hepatotoxic risks and the need for LFTs, and review all current medicines for opioid content.
Discuss common side‑effects such as nausea, headache and sleep disturbance, and advise on driving and working if concentration may be affected.
NHS Patient Safety Advice
Stress that naltrexone is one part of a comprehensive plan including psychosocial support and that any signs of liver dysfunction or severe mood changes should prompt immediate review.
- Counselling Checklist: confirm opioid history, give written side‑effect advice, explain missed‑dose rules, and provide emergency contacts and follow‑up arrangements.
Document counselling in the patient record and provide a printed leaflet summarising key points and local addiction service contacts.
Delivery Across United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 5-7 days |
| Birmingham | England | 5-7 days |
| Manchester | England | 5-7 days |
| Glasgow | Scotland | 5-7 days |
| Leeds | England | 5-7 days |
| Edinburgh | Scotland | 5-7 days |
| Liverpool | England | 5-7 days |
| Bristol | England | 5-7 days |
| Sheffield | England | 5-9 days |
| Newcastle Upon Tyne | England | 5-9 days |
| Nottingham | England | 5-9 days |
| Cardiff | Wales | 5-9 days |
| Belfast | Northern Ireland | 5-9 days |
Final Notes And Practical Tips
Feeling unsure about starting treatment is normal; ask your prescriber for a clear plan on how naltrexone will be integrated with psychological support.
Carry a short card stating you are taking an opioid antagonist so emergency clinicians know that opioid analgesia will be blocked.
Keep copies of baseline tests and treatment plans, and make sure any advice about driving or safety‑critical work is written down and placed in your clinical record.
If you have questions about brands such as Revia, generics or Vivitrol, your pharmacist can explain availability and what to expect from each formulation.
