Naltrexone (Vivitrol, LDN) and Ketamine Therapy | Tovani Health
Vivitrol (Naltrexone) (also: ReVia) — Opioid receptor antagonist (AUD, OUD, low-dose chronic pain)
Verdict at Tovani Health
Mechanism is opposite to opioids; the specific use case (AUD vs OUD vs LDN) matters.
Naltrexone alongside ketamine requires individual evaluation. It does NOT block ketamine itself (ketamine works at NMDA receptors, not opioid receptors), but the clinical context matters: full-dose naltrexone for opioid use disorder is fine; full-dose for alcohol use disorder is fine; low-dose naltrexone (LDN) for chronic pain or autoimmune conditions is generally fine. We do not turn naltrexone patients away, but we plan around the underlying condition.
If you take Vivitrol regularly and are considering at-home ketamine therapy, the combination is depends on your specific situation. This page covers the brief pharmacologic context and what we do at intake.
How Vivitrol interacts with ketamine
Naltrexone competitively blocks mu, kappa, and delta opioid receptors. Ketamine has minor mu-opioid activity at higher doses but its primary mechanism is NMDA antagonism, which naltrexone does not affect. Some preclinical work suggests naltrexone may modestly reduce ketamine's antidepressant effect via mu-opioid mediation; the clinical magnitude is debated.
What we do at intake
Disclose dose, indication (alcohol use disorder, opioid use disorder, low-dose pain), and timing. For Vivitrol (monthly injection), tell us when your last shot was. We coordinate with your prescriber if you are in OUD recovery.
Bottom line
Naltrexone alongside ketamine requires individual evaluation. It does NOT block ketamine itself (ketamine works at NMDA receptors, not opioid receptors), but the clinical context matters: full-dose naltrexone for opioid use disorder is fine; full-dose for alcohol use disorder is fine; low-dose naltrexone (LDN) for chronic pain or autoimmune conditions is generally fine. We do not turn naltrexone patients away, but we plan around the underlying condition.
Frequently Asked Questions
Will naltrexone block ketamine from working?
Not block, but possibly modestly attenuate. The clinical signal is small and we have many patients who respond well to KAP while on naltrexone.
I take low-dose naltrexone for chronic pain. Is that different?
Yes. LDN doses are too low to meaningfully affect ketamine. We treat LDN as fully compatible.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Vivitrol (Naltrexone) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism. Williams NR, Heifets BD, Blasey C, et al.. American Journal of Psychiatry. 2018. PMID: 30153752
Landmark study showing pretreatment with naltrexone (opioid receptor antagonist) blocks the antidepressant effect of ketamine.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 16, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.