Vivitrol is a long-acting form of naltrexone used to treat alcohol dependence and help prevent relapse to opioid dependence after detoxification. Because it is given as an injection about once a month, it can be an option for people who prefer not to take a daily medication.
Understanding how Vivitrol works is especially important because it has different initiation requirements from many other medications used in opioid use disorder treatment. People must be opioid-free before starting it, and treatment requires medical oversight. Vivitrol also works best within a broader plan that may include counseling, behavioral support, and ongoing healthcare.
What Is Vivitrol?
Vivitrol is a prescription form of extended-release naltrexone, an opioid antagonist. Naltrexone attaches to opioid receptors and blocks opioid effects. Vivitrol is not an opioid and is not considered addictive.
Unlike oral naltrexone, which is taken as a pill, Vivitrol is a long-acting injection administered by a healthcare professional every four weeks or about once a month.
What Is Vivitrol Used For?
Vivitrol has two FDA-approved indications: treatment of alcohol dependence and prevention of relapse to opioid dependence after opioid detoxification. In both cases, it should be used as part of a broader treatment program.
Vivitrol for Alcohol Dependence
The FDA labeling uses “alcohol dependence,” while alcohol use disorder is the diagnostic term commonly used in current clinical practice. Patients should be able to abstain before beginning Vivitrol and should not be actively drinking when they receive the first injection.
Naltrexone may reduce some of alcohol’s rewarding effects and the urge to drink. Response varies, so it should not be described as eliminating cravings or guaranteeing abstinence.
Vivitrol for Opioid Dependence
For opioids, Vivitrol is approved to help prevent relapse after detoxification. It does not treat acute opioid withdrawal and should not be started while someone is physically dependent on opioids.
How Does Vivitrol Work?
Naltrexone blocks opioid receptors in the brain. With opioid use, this prevents or reduces the euphoric and sedating effects opioids would otherwise produce. With alcohol dependence, blocking opioid-receptor activity may reduce alcohol’s reinforcing effects and the urge to drink.
Vivitrol does not create an opioid effect or replace one opioid with another. Medication alone, however, does not address every behavioral, mental health, or social factor involved in recovery.
How Is Vivitrol Given?
A healthcare professional administers Vivitrol as a deep intramuscular injection in the buttock. The standard labeled dose is 380 mg every four weeks or once monthly. It is not a medication patients administer on their own.
Regular appointments also allow the care team to review side effects, other medications, substance use, and treatment progress.
Why Do You Need to Be Opioid-Free Before Vivitrol?
Starting Vivitrol while opioids are still present or while physical dependence remains can cause precipitated withdrawal. This can begin abruptly and may be severe enough to require hospital care.
The FDA labeling recommends an opioid-free period of at least 7 to 10 days before treatment. The appropriate interval can vary based on recent opioid use and the clinical situation. People transitioning from buprenorphine or methadone may remain vulnerable to precipitated withdrawal for as long as two weeks. The treating clinician should determine when it is safe to begin.
What Are the Potential Benefits of Vivitrol?
Possible advantages include:
- Monthly rather than daily dosing
- No opioid agonist effects
- Reduced rewarding effects from opioids
- Support for reducing alcohol use or maintaining abstinence
- Fewer opportunities to miss a daily dose
Whether Vivitrol is appropriate depends on medical history, recent substance use, treatment preferences, pain-management needs, and prior medication response.
Common Vivitrol Side Effects
Reported Vivitrol side effects include:
- Nausea or vomiting
- Injection-site pain, swelling, itching, or a lump
- Headache or dizziness
- Sleep changes
- Tiredness or sedation
- Reduced appetite
Side effects vary by indication and individual response. New, persistent, or severe symptoms should be discussed with the prescribing clinician.
Important Risks and Safety Considerations
Opioid Withdrawal
Vivitrol can trigger sudden withdrawal when started before a person has been opioid-free long enough. Tell the prescriber about any recent opioid use, including prescription pain medication, buprenorphine, methadone, and tramadol.
Opioid Overdose Risk
Following Vivitrol treatment, opioid tolerance may be lower than it was before treatment. Trying to overcome the medication’s opioid blockade with large opioid doses can cause a fatal overdose. Risk also increases near the end of a dosing interval, after a missed injection, or after treatment stops because a previously tolerated opioid dose may no longer be safe. The prescribing information recommends discussing access to an opioid overdose reversal medication, such as naloxone, at the initial injection and each subsequent injection.
Liver Health and Other Warnings
Cases of hepatitis and clinically significant liver dysfunction have been reported with Vivitrol. Serious injection-site reactions are also possible. The prescribing information advises monitoring for new or worsening depression or suicidal thinking. Significant symptoms or mood changes should be reported to a healthcare professional.
Vivitrol vs. Oral Naltrexone
Vivitrol and oral naltrexone contain the same active medication but differ in how they are taken. Oral naltrexone is generally taken daily, while Vivitrol releases naltrexone over several weeks after a monthly injection.
The injection may help people who have difficulty taking a daily pill consistently. Oral medication may be preferable for others. A clinician can weigh adherence, medical history, and treatment preferences.
Vivitrol vs. Buprenorphine Medications
Vivitrol and buprenorphine are both evidence-based medication options for opioid use disorder, but they work differently. Vivitrol is an opioid antagonist. Buprenorphine is a partial opioid agonist that activates opioid receptors in a controlled way to reduce withdrawal symptoms and cravings.
They also have different initiation requirements. Vivitrol requires an adequate opioid-free interval, while traditional buprenorphine initiation generally begins once objective signs of opioid withdrawal are present. Treatment choice depends on the individual and the specific medication protocol.
What Should You Discuss With Your Provider Before Starting Vivitrol?
Important topics include:
- Recent opioid or alcohol use
- Prescription and nonprescription medications
- Liver or kidney history
- Pregnancy or breastfeeding
- Current or anticipated pain-management needs
- Previous addiction-treatment medications
- Mental health symptoms and treatment
- What to do if an injection is delayed or missed
Pregnancy data for Vivitrol remain limited, making an individualized discussion with a healthcare provider especially important for anyone who is pregnant, planning pregnancy, or breastfeeding.
How Vivitrol Fits Into a Comprehensive Treatment Plan
Vivitrol’s FDA labeling states that treatment should be part of a comprehensive program that includes psychosocial support. Depending on the person, that may include counseling, behavioral therapies, peer or family support, treatment for co-occurring mental health conditions, and ongoing medication monitoring.
For people who are also managing mental health symptoms, medication management can support ongoing review of psychiatric medications, side effects, and treatment response.
Finding the Right Medication Plan
Finding the right medication plan starts with understanding your full health history, current medications, and treatment goals. If you’re managing a mental health condition alongside substance use or recovery concerns, talk with a qualified healthcare provider about the treatment options that may be appropriate for you.
Contact Pulse TMS to learn more about mental health treatment options that may support your broader care plan.
Frequently Asked Questions
Is Vivitrol an opioid?
No. Vivitrol contains naltrexone, an opioid antagonist. It blocks opioid receptors rather than activating them.
Can Vivitrol cause withdrawal?
It can precipitate severe opioid withdrawal if it is given while opioids remain in the body or physical dependence is still present. A healthcare professional should determine when initiation is appropriate.
Does Vivitrol help with alcohol cravings?
Naltrexone may reduce the urge to drink and the rewarding effects associated with alcohol for some people. Individual response varies.
How long does Vivitrol last?
Vivitrol is formulated for dosing every four weeks or about once a month. Your provider will determine the appropriate schedule.
Can You Take Opioids While Receiving Vivitrol?
Vivitrol blocks opioid effects and can complicate opioid pain treatment. Trying to override that blockade can be dangerous. Tell healthcare professionals that you receive Vivitrol, especially before surgery, dental procedures, or treatment for acute pain.
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