Basic Revia Information

• INN (International Nonproprietary Name): Naltrexone hydrochloride.
• Brand Names Available In Canada (English): Revia; Depade; Vivitrol; Naltrexona (generic) — status varies by region; Revia brand discontinued in many regions, generics available.
• ATC Code: N07BB04 — Other Nervous System Drugs; Drugs Used In Alcohol Dependence.
• Forms & Dosages: Tablet 50 mg oral (film-coated, scored; blisters or bottles); Prolonged-Release Injection 380 mg/vial IM (powder for reconstitution, single-use vial).
• Manufacturers In Canada (English): not specified; world suppliers include Alkermes (Vivitrol), and generics from Teva, Sandoz, Accord Healthcare; Mallinckrodt was original supplier of Revia (now discontinued).
• Registration Status In Canada (English): not specified.
• OTC / Rx Classification: Prescription Only (Rx).

Latest Research Highlights

Worried whether naltrexone really helps prevent relapse?

Research from 2022–2025, including Canadian observational cohorts and international meta-analyses, continues to support naltrexone’s role in relapse prevention for alcohol use disorder and as part of medication-assisted treatment for opioid use disorder.

Canadian observational studies report improved short-term abstinence and fewer heavy-drinking days when naltrexone is combined with counselling.

International meta-analyses show modest-to-moderate effect sizes versus placebo for reducing heavy drinking or preventing relapse in alcohol use disorder.

Recent work emphasises adherence benefits with extended-release injectable formulations such as Vivitrol compared with daily oral dosing.

Safety surveillance since 2022 has focussed on hepatotoxicity signals and careful patient selection, with baseline and periodic liver enzyme monitoring recommended.

Practical trial findings reinforce the need to start naltrexone only after a 7–10 day opioid-free interval to avoid precipitated withdrawal.

Clinical Effectiveness In Canada

Wondering how Health Canada and provinces view naltrexone?

Canadian clinical guidance and Health Canada–monitored summaries position naltrexone as an evidence-based treatment for AUD and as part of MAT for OUD when combined with psychosocial supports.

Health Canada approval covers prescription use, with product availability varying by region; Revia has been discontinued in many regions while generics and Vivitrol injectable remain.

Provincial formularies list naltrexone variably — some cover extended-release injections for selected populations and others list oral tablets on restricted benefits.

Pharmacists should verify the DIN on the product label and confirm provincial formulary rules such as ODB, BC PharmaCare or RAMQ before counselling on coverage.

Clinicians in Canada emphasise shared decision-making, bilingual consent materials and easier access through major chains, though rural supply gaps persist.

Indications And Expanded Uses

Want to know what naltrexone is officially used for?

Approved, research-backed indications include alcohol dependence (AUD) and relapse prevention for opioid dependence as part of MAT, with extended-release naltrexone 380 mg IM approved for monthly use.

International regulators such as the FDA and EMA list similar indications for naltrexone products.

Off-label uses described in the literature include certain impulse-control disorders, pathological gambling and as adjunctive treatment in binge-eating disorder, though evidence for these is limited and mixed.

Clinicians should document rationale and obtain informed consent for any off-label prescribing.

• Approved Indications: Oral 50 mg daily for AUD and OUD relapse prevention; Vivitrol 380 mg IM every 4 weeks for monthly use.
• Off-Label Indications: Pathological gambling (evidence level: low), impulse-control disorders (evidence level: low), adjunct for binge-eating disorder (evidence level: mixed/low).

Definitions:

• AUD: Alcohol Use Disorder.
• OUD: Opioid Use Disorder.
• MAT: Medication-Assisted Treatment.
• Extended-Release: Monthly intramuscular formulation (Vivitrol).

Cultural note: Indigenous and immigrant communities may prefer traditional supports, and culturally safe approaches improve engagement and outcomes.

Composition And Brand Landscape

Curious which brands and forms you might see on the shelf?

The INN is naltrexone hydrochloride and standard market forms are 50 mg oral tablets and 380 mg intramuscular prolonged-release vials.

Revia historically represented the 50 mg tablet, but the brand is discontinued in many regions and pharmacies primarily dispense generics.

Vivitrol by Alkermes supplies the extended-release injectable globally and remains available.

• Pros Of Tablets: Lower cost, familiar packaging, flexible dosing.
• Cons Of Tablets: Daily adherence required; stigma around daily pills for addiction.
• Pros Of Injectable Vivitrol: Monthly dosing improves adherence and reduces daily-pill burden.
• Cons Of Injectable: Higher product and administration cost; clinic visit required.

Packaging sold in Canada must include bilingual labelling and pharmacists should always check DIN and lot number at dispensing.

Contraindications And Special Precautions

Worried about liver risk or triggering withdrawal?

Absolute contraindications include current opioid use or risk of precipitated withdrawal, acute hepatitis or significant hepatic impairment, and known hypersensitivity to naltrexone or excipients.

Relative contraindications that require close monitoring include moderate hepatic or renal impairment and a history of depression or suicidal ideation.

Clinical guidance since 2022 emphasises hepatotoxicity risk at high doses or in pre-existing liver disease, so baseline and periodic LFTs are standard practice.

• Absolute Contraindications: Recent opioid use (risk of precipitated withdrawal); acute hepatitis; severe hepatic impairment; known hypersensitivity.
• Relative Contraindications: Moderate liver or kidney impairment; active major depression or suicidal ideation.

Decision flow (brief): if opioids used within 7–10 days, defer initiation; if LFTs show acute hepatitis or marked elevation, defer and investigate; if moderate liver disease, consider specialist input and close monitoring.

Patient-centred note: Indigenous, elderly and patients with psychiatric comorbidity often need additional supports and culturally safe informed consent processes.

Dosage Guidelines

How should naltrexone be started and dosed safely?

Standard adult dosing is oral naltrexone 50 mg once daily for AUD and OUD relapse prevention and extended-release injection naltrexone 380 mg IM every 4 weeks.

Initiation requires an opioid-free interval of typically 7–10 days to avoid precipitated withdrawal when treating OUD.

• Missed Dose: Take as soon as remembered unless close to the next scheduled dose; do not double up.
• Overdose: Seek emergency care; monitor for hepatotoxicity and liver failure signs.

For pediatrics, safety under 18 is not established; for elderly, use caution and monitor renal and hepatic function.

Provincial formularies often require prior authorization for injectable forms and including the product DIN on prescriptions helps speed coverage decisions.

Practical adherence supports include pill boxes, SMS reminders or choosing monthly injection when appropriate and accessible.

Interactions Overview

What drugs and situations can cause problems with naltrexone?

The most important interaction is with opioids: naltrexone blocks opioid receptors and can precipitate acute withdrawal if opioids are present.

Concomitant hepatotoxic agents such as high-dose acetaminophen increase cumulative liver injury risk and warrant caution.

Although pharmacokinetic interactions are limited, caution is advised with sedative-hypnotics including benzodiazepines and alcohol because combined CNS effects and relapse risk complicate management.

Patient-centred action: advise patients to inform emergency services and all prescribers that they are taking naltrexone because opioid analgesia may be ineffective.

Provide a wallet card and bilingual handout when possible to avoid treatment delays in acute pain situations.

Cultural Perceptions And Patient Habits

Do people accept medication for addiction treatment?

Canadian forums and qualitative research show mixed perceptions: many patients see MAT as pragmatic and lifesaving, while others worry about medicalisation or stigma from taking daily medication.

Rural patients report access barriers to extended-release injections because clinic availability is limited, while urban centres often run clinic-based Vivitrol programs.

Bilingual resources and culturally adapted education—especially for Indigenous, francophone and immigrant groups—improve uptake and trust.

• Common Patient Concerns: Side effects such as nausea and insomnia; liver safety; stigma of daily pills for addiction.
• Facilitators Of Uptake: Monthly injections reduce pill burden; integrated counselling; peer support and program continuity.
• Communication Tactics: Plain language counselling, translated materials and culturally safe shared decision-making.

Pharmacy note: major chains including Shoppers Drug Mart, Rexall, London Drugs and Jean Coutu can assist with counselling and coverage paperwork, while smaller rural pharmacies may need to special-order stock or coordinate injection appointments.

Availability And Pricing Patterns

How much will naltrexone cost and where can it be found?

In Canada, oral generics are common and the Revia brand has been discontinued in many regions, while Vivitrol injectable remains available.

Oral generics are usually less expensive than branded products, and the injectable Vivitrol carries higher cost due to product price and administration fees.

Provincial drug plans such as ODB, BC PharmaCare and RAMQ have different listing criteria; some require prior authorization or limit coverage to structured programs.

In our online pharmacy, revia is available without a prescription, with discreet delivery to Canada (English) in 5-14 days.

Cross-border note: US prices may be lower at times but involve prescription transfer rules and import restrictions; travellers should check Health Canada rules and carry original packaging and DIN when crossing borders.

Always verify the DIN on product labels and receive pharmacist counselling before purchase.

Comparable Medicines And Preferences

What are the main alternatives to naltrexone?

Treatment choices for AUD and OUD vary by mechanism, patient goals and access to care.

Pros of naltrexone include being a non-opioid antagonist and the availability of a once-monthly injectable to improve adherence.

Cons include the inability to use it with ongoing opioid use and the need for liver monitoring.

Match treatment to goals such as abstinence versus harm reduction and consider pregnancy plans and psychiatric comorbidities when choosing therapy.

FAQ

Q: Can I drive while taking naltrexone?

A: Most patients can drive while taking naltrexone; monitor for dizziness, fatigue or sedation and avoid heavy alcohol consumption.

Q: Will naltrexone stop pain relief if I need opioids?

A: Yes — naltrexone blocks opioid effects and can make opioid analgesia ineffective; notify all care teams and carry a wallet card stating current naltrexone use.

Q: Is naltrexone covered by my provincial plan?

A: Coverage varies between provincial programs such as ODB, BC PharmaCare and RAMQ; coverage may require prior authorization and DIN submission to speed approval.

Q: What if I’m pregnant or breastfeeding?

A: Evidence is limited and the risk/benefit must be discussed with a specialist; consider counselling and alternative supports during pregnancy and lactation.

Action Steps For Patients:

• Check the product DIN and provincial formulary before filling a prescription.
• Speak to a pharmacist for counselling on interactions and liver monitoring.
• Obtain baseline LFTs and arrange psychosocial supports before or soon after starting therapy.

Guidelines For Proper Use

What should clinicians and pharmacists verify before dispensing?

Verify opioid abstinence for 7–10 days prior to initiation to avoid precipitated withdrawal.

Obtain baseline liver function tests and a mental health screen before starting naltrexone.

Confirm the product DIN and provincial coverage to reduce delays in reimbursement and supply.

Provide bilingual (EN/FR) counselling and written instructions including a wallet card for emergency settings.

Storage rules: tablets should be stored at 20–25°C and protected from moisture and heat; injections must be refrigerated and reconstituted per the product monograph.

Monitoring Schedule:

• Baseline: ALT/AST and general liver screen.
• 1–2 Months: Repeat LFTs after initiation.
• Ongoing: Periodic monitoring as clinically indicated or if symptoms suggest liver dysfunction.

Counselling Checklist For Dispensing:

• Explain missed-dose guidance and emphasise not to double doses.
• Warn against opioid use and provide instructions for emergency teams if acute pain arises.
• Offer culturally safe counselling and connect to local psychosocial therapy and peer supports.
• Coordinate injectable appointments for rural patients and assist with coverage paperwork using resources from major pharmacy chains.

Delivery Across Canada (English)