Naltrexone Shortage: What Providers and Prescribers Need to Know in 2026

The naltrexone hydrochloride oral tablet shortage that began in February 2024 remains active in 2026. For prescribers managing patients with alcohol use disorder (AUD) and opioid use disorder (OUD), this shortage creates real clinical challenges — patients running out of medication, risking relapse, and needing guidance on alternatives.

This guide is designed for healthcare providers: primary care physicians, psychiatrists, addiction specialists, nurse practitioners, and physician assistants who prescribe naltrexone for AUD or OUD treatment.

Current Shortage Status (2026)

ASHP and Drugs.com maintain active shortage bulletins for naltrexone hydrochloride tablets (50 mg), first posted February 29, 2024. As of 2026:

Available manufacturers: Accord Healthcare (NDC 16729-0081), Major Pharmaceuticals (NDC 0406-1170), Sun Pharmaceutical (NDC 62135-242), Chartwell (60-count bottles), and Precision Dose (NDC 68094-909) are reporting available stock as of early 2026.

Discontinued products: Avet Pharmaceuticals and Tagi Pharma have permanently discontinued all naltrexone tablet NDCs.

Limited availability: One Sun Pharmaceutical NDC (47335-326-88) reported limited availability in December 2025, with additional supply anticipated in early 2026.

Vivitrol unaffected: Alkermes reports no supply disruption for Vivitrol (naltrexone extended-release injectable, 380 mg/vial).

Root Causes of the Shortage

Prescribers should understand the structural factors driving this shortage, as they affect the long-term supply outlook:

DEA-regulated API (thebaine): Naltrexone requires thebaine as a precursor, which is also used for oxycodone, hydrocodone, buprenorphine, and naloxone. DEA quotas limit total importation, and manufacturers prioritize higher-margin products.

Demand surge: Post-pandemic AUD rates and expanded telehealth access significantly increased naltrexone prescribing volume, outpacing existing production capacity.

Low profit margin: Generic naltrexone costs roughly $32-$90 per 30-day supply at retail. Manufacturers have little financial incentive to invest in expanded capacity relative to more profitable generics.

Long production cycle: New naltrexone tablet production takes 6+ months from API procurement to finished product, limiting the speed with which manufacturers can respond to demand increases.

Clinical Management: Oral Tablets

For patients currently stabilized on oral naltrexone 50 mg:

Proactively call ahead to pharmacies or use a service that checks pharmacy inventory before sending patients to pick up prescriptions. This prevents patients from discovering the shortage at the counter.

Authorize 90-day supplies whenever insurance permits. This provides a supply buffer against future shortages.

Educate patients to request refills 2 weeks before running out, not when they take their last pill.

Identify which pharmacies in your area reliably stock naltrexone and provide patients with a list.

Clinical Management: Transitioning to Vivitrol

For appropriate patients, Vivitrol (380 mg IM monthly) is a viable option that bypasses the tablet shortage entirely. Advantages for patients during the shortage period include:

No monthly pharmacy visit — administered in-office or at a clinic

Improved compliance (no daily pill to remember)

Manufacturer copay savings program: 9 out of 10 commercially insured patients pay less than $5/injection through Vivitrol2gether

Note: Only the injectable Vivitrol formulation is FDA-approved specifically for OUD treatment; both formulations are approved for AUD.

Clinical Alternatives When Naltrexone Is Unavailable

For AUD patients: Acamprosate (Campral) 333 mg TID is a first-line alternative, especially preferred in patients with hepatic impairment as it is renally rather than hepatically metabolized. Disulfiram (Antabuse) is an option for highly motivated patients with close follow-up, noting its own hepatotoxic potential and requirement for strict alcohol abstinence.

For OUD patients: Buprenorphine/naloxone (Suboxone) is the FDA-recommended first-line treatment for OUD and has stronger evidence for mortality reduction than naltrexone. The 2022 MAT Act eliminated the X-waiver requirement, so any DEA-licensed Schedule III prescriber can now prescribe buprenorphine for OUD. Methadone remains an option for patients who require structured opioid treatment program (OTP) dispensing.

Compounding as a Bridge Option

Compounding pharmacies may be able to prepare naltrexone capsules or liquids when commercial tablets are unavailable. This is particularly relevant for patients on low-dose naltrexone (LDN) for off-label indications (fibromyalgia, autoimmune conditions), as LDN doses (1.5-4.5 mg) are not commercially available in any form. Verify that the compounding pharmacy you refer patients to is PCAB-accredited or state-licensed for sterile compounding as appropriate.

Safety Considerations: Relapse Risk After Naltrexone Discontinuation

If patients are forced to discontinue naltrexone due to supply interruption, counsel them specifically on overdose risk if they return to opioid use. Naltrexone reduces opioid tolerance; patients who relapse after stopping naltrexone may overdose on doses they previously tolerated. This FDA warning should be communicated proactively before any anticipated discontinuation.

Helping Your Patients Find Naltrexone

medfinder offers a provider portal at medfinder.com/providers to help clinical staff locate which pharmacies near your patients have naltrexone in stock, saving your team and your patients time during the shortage.

Also see: How to Help Your Patients Find Naltrexone in Stock: A Provider's Guide.