Overview of Vivitrol (Naltrexone)

Vivitrol is a brand name formulation for naltrexone. It can be used to help people maintain abstinence while recovering from an opioid or alcohol dependence. Other formulations of naltrexone are available in oral tablet form, but Vivitrol is administered as an intramuscular solution once per month
 Overview of Vivitrol (Naltrexone)

It is important people in treatment for an addiction to opioids first completely detox from these substances and then maintain abstinence for 7-10 days prior to starting Vivitrol; otherwise, this prescription medication can elicit 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

In some cases, naltrexone injections can also cause reactions at the injection site, eosinophilic pneumonia, and liver toxicity. However, it can be very beneficial for many people working to manage their addiction to alcohol or opioids because it helps to reduce cravings after the body has detoxed. Unlike opioid agonist medications used to treat opioid addiction, like methadone or buprenorphine naltrexone does not cause any euphoria, so there is no associated intoxication or abuse liability.

Vivitrol for Alcohol Addiction

Initially, Vivitrol was approved by the Food and Drug Administration in 2006 to prevent relapse in those recovering from an alcohol use disorder. Naltrexone works to minimize cravings for alcohol via a different mechanism than previously used alcohol relapse prevention medicines, like disulfiram, which discourages continued drinking by making those in recovery sick if they consumed alcohol.

Vivitrol has been effective in augmenting recovery from addiction to alcohol. In a six-month double-blind study, people who used Vivitrol with counseling to treat an alcohol use disorder experienced a 25 percent greater reduction in the number of heavy drinking days after they graduated from treatment. Overall, people whose alcohol use disorder was treated with both Vivitrol and rehabilitation counseling spent more time abstinent from alcohol and had lower rates of relapse.

Naltrexone’s theorized mechanism of action stems from the fact 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 being treated for alcohol use disorders, Vivitrol, an opioid receptor antagonist, 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 greatly diminished. 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 being treated for opioid addictions. 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 opioid receptors in people who consume alcohol, it also directly blocks opioid drugs from binding to opioid receptors in the brain. This can make it a much more effective treatment for opioid addiction, as it helps prevents relapse. People who use Vivitrol in combination with counseling to treat 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.

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, with opioid agonist medications like buprenorphine, Vivitrol will stop the medicine from working and make withdrawal symptoms worse. Naltrexone is a pure opioid antagonist, meaning it does not allow other drugs to bind to opioid receptor cells.

How Do Doctors Prescribe Vivitrol?

Doctors who prescribe Vivitrol and other FDA approved substance abuse treatment medications require special training before they can administer these drugs to patients overcoming alcohol or opioid addiction; however, relatively 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 a combination of medications, rehab, counseling, and 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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