Overview of Vivitrol (Naltrexone)

Vivitrol is the brand name for a formula of naltrexone, developed and manufactured by Alkermes. It can be used to help people overcoming alcohol use disorder and opioid addiction maintain abstinence. There are other versions of naltrexone that come in pill form, but Vivitrol is a once-per-month intramuscular injection.
 Overview of Vivitrol (Naltrexone)

It is important that people ending their addiction to either opioids or alcohol successfully detox from these drugs and maintain abstinence for 7-10 days prior to starting Vivitrol; otherwise, this prescription medication can cause withdrawal symptoms.

All forms of naltrexone work by stopping the euphoria and sedation that central nervous system depressants, specifically alcohol and opioids, can cause. The medicine binds to those receptor sites in lieu of the intoxicating substances and stays there for a long time. When a person taking any form of naltrexone as prescribed relapses, the drug will not bind to the opioid receptor sites, so there will be no high associated with using the substance after detoxing.

Side effects of naltrexone include:

  • Diarrhea
  • Upset stomach
  • Headache
  • Restlessness or nervousness
  • Exhaustion or sleep problems
  • Muscle or joint pain

Naltrexone injections can also cause reactions at the injection site, allergic pneumonia, or liver damage. However, it can be very beneficial for many people working to end an addiction to alcohol or opiates because it helps to reduce cravings after the body has detoxed. Unlike medications used to ease people off opioid addiction, like methadone or buprenorphine, naltrexone does not cause any euphoria, so there is no associated intoxication.

Vivitrol for Alcohol Addiction

Initially, Vivitrol was approved by the Food and Drug Administration in 2006 to prevent relapse after overcoming alcohol addiction. The medicine works by stopping cravings for alcohol instead of causing physical illness when alcohol is consumed. Earlier alcohol relapse prevention medicines, like disulfiram, made those in recovery sick if they consumed alcohol.

Vivitrol has been effective for many people ending their addiction to alcohol. In a six-month double-blind study, people who used Vivitrol with counseling to end their alcohol use disorder experienced a 25 percent greater reduction in the number of heavy drinking days after they graduated from treatment. Overall, people overcoming alcohol use disorder with Vivitrol and rehabilitation counseling spent more time abstinent from alcohol and had lower rates of relapse.

Naltrexone medicines work on the theory that intoxicating substances like alcohol release endorphins, making the person feel good. This reinforces, in classic Pavlovian fashion, the want and then the need to drink more to feel good. In people who are ending alcohol use disorder, Vivitrol blocks the endorphins from binding to their receptors, thereby ending the good feeling associated with being drunk. There may be some other signs of intoxication, but the pleasure of drinking will be gone. Among people who relapse into old patterns of alcohol use, the drive to drink should gradually disappear since it no longer offers perceived benefits.

Vivitrol for Opioid Addiction

Vivitrol was approved by the FDA in 2010 to help people who are ending their addiction to opioids. While it was known that Vivitrol could help people struggling with alcohol use disorder, the drug was approved to also help prevent opioid relapse after a study showed that people who took the medication during rehabilitation stayed in the program longer and were more likely to remain abstinent and avoid relapse.

Although it is useful in preventing relapse, it is important to successfully complete a detox program and have no opioids left in the body or withdrawal symptoms before beginning Vivitrol. This is because naltrexone will remove opioids from opioid receptors, so if a person is undergoing medically assisted detox, such as by using buprenorphine, Vivitrol will stop the medicine from working and make withdrawal symptoms worse. It is a pure opiate antagonist, meaning it does not allow other drugs to bind to opioid receptor cells.

While Vivitrol stops endorphins from binding to receptors cells in people who consume alcohol, it directly blocks opioids from binding to opioid receptors in the brain. This can make it a much more effective treatment for opioid addiction, as it prevents relapse. People who use Vivitrol in combination with counseling to end their opioid addiction have 90 percent opioid-free weeks compared to 35 percent who took a placebo. Those who used Vivitrol alongside rehabilitation and continuing therapy were 17 times less likely to relapse compared to those who did not use Vivitrol.

Is the Vivitrol Implant Effective?

Is the Vivitrol Implant Effective?

The drug is available via an implant that releases Vivitrol into the body after being inserted into the lower abdominal wall. The drug releases for three or six months. However, these implants are not approved by the FDA, and they are only used in clinical settings with 24-hour supervision.

They are touted as a “cure” for opioid addiction, using a process called rapid detox. The presence of naltrexone kicks opioids or alcohol out of the body very quickly, and the person experiences withdrawal for a few days rather than one to two weeks.

However, the intensity of this experience means that many people are sedated and hospitalized during this process. Detox only means the body is no longer physically dependent on opioids or alcohol, not that the person has overcome their addiction. Addictive behaviors, cravings, and underlying triggers have not been addressed, so the Vivitrol implant is not successful at ending addiction. While it may have some use for some people, it is no substitute for going through comprehensive rehabilitation. Vivitrol should be used as the FDA has approved it – as a once-per-month shot, designed to ease cravings and help prevent relapse after a person has detoxed. Any form of naltrexone should be prescribed alongside psychotherapy, not in place of counseling.

How Do Doctors Prescribe Vivitrol?

Doctors who prescribe Vivitrol require special training before they can work with patients overcoming alcohol or opioid addiction; however, few go through the training to prescribe these medicines due to a lingering perception that Vivitrol and other naltrexone medicines are not effective in treating substance abuse. This is likely due to studies in which people ending an addiction to alcohol or opioids like heroin used only naltrexone, not rehab, counseling, or mental health treatment.

There is no magic prescription cure to end alcohol use disorder or opioid addiction. Although Vivitrol is a great option to help many people, like other medications to treat addiction, it must be used in combination with psychotherapy. Therapy offers social support, retraining of problematic behaviors, and a deeper understanding of how the addiction began.

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