Revia interactions — what to avoid and practical advice

Revia (naltrexone) blocks opioid receptors. That makes it useful for alcohol dependence and opioid use disorder, but it also creates important drug and safety concerns. Read this if you or someone you care for is starting Revia — it answers the common, practical questions people forget to ask.

Opioids and pain medicines: the biggest interaction

Do not use opioid painkillers while on Revia. If you take an opioid after starting Revia you can get sudden, severe withdrawal. You also won’t get pain relief from opioid medicines — which matters if you need surgery. If you expect to need opioids, talk to your doctor first. For oral Revia you usually need to be opioid-free for at least 7–14 days before starting it; if you’re switching from a long-acting opioid or methadone, the wait is longer and needs specialist input. For planned surgery, your team may pause Revia so standard pain control works.

Other medicines, liver safety, and common questions

Naltrexone can stress the liver at high doses or in people with liver disease. Get baseline liver tests (ALT/AST) before starting and repeat as recommended by your prescriber. If you have active hepatitis or very high liver enzymes, your doctor may avoid Revia.

There are no major interactions with most antidepressants or benzodiazepines, but watch for extra tiredness or mood changes. If you take bupropion or other seizure‑risk drugs, mention that — some combinations can raise seizure risk. Also tell your provider about herbal or OTC products that contain opioids (some cough syrups, kratom, or poppy-derived products). Even small opioid doses can trigger withdrawal or block pain control.

Mixing Revia with heavy alcohol use plus other liver‑risk drugs (like high-dose acetaminophen) raises the chance of liver injury. Avoid binge drinking and limit medicines that strain the liver while you’re on treatment.

Planning surgery or dental work? Tell every clinician and anesthetist you take Revia. Anesthesia teams need to know so they can plan non‑opioid pain control or temporarily stop Revia if necessary.

Practical tips: always list Revia on your med list, carry a card or set a phone note about the risk with opioids, and ask your prescriber how long to stop Revia before any planned opioid use. If someone on Revia uses an opioid and becomes very sick or heavily sedated, call emergency services — opioids may have reduced effects, but risks remain.

If you’re unsure about a specific drug or supplement, check with your prescriber or pharmacist. They can look up interactions and give a safe plan tailored to your health and upcoming procedures.