Vivitrol for Opioid and Alcohol Addiction: Side Effects, Benefits & Risks

Vivitrol is a long-acting injectable form of naltrexone. It is used in the maintenance treatment of opioid or alcohol dependence.

Vivitrol is the brand name of a medication known as naltrexone. Vivitrol is available as a long-acting injection. It is FDA-approved for the treatment of alcohol or opioid dependence.

What Is Vivitrol?

Vivitrol, the injectable form of naltrexone, is an opioid antagonist. As an antagonist, it binds opioid receptors without turning them on. By blocking opioid receptors, Vivitrol prevents the potentially harmful opioid side effects. These include reduced breathing and circulatory collapse. The medication also works to reduce cravings and urges for opioids. The Food and Drug Administration (FDA) approved Vivitrol for alcohol dependence in April 2006. Four years later, it was approved for opioid dependence in October 2010.

How Does Vivitrol Work?

Central nervous system (CNS) depressants like opioids and alcohol cause euphoria and relaxation. Vivitrol, an opioid antagonist, binds to opioid receptors in the brain. This prevents enjoyable sensations from opioids and alcohol. Vivitrol also lessens the desire for and urges to use these substances. Vivitrol’s active ingredient, naltrexone, is safe and effective for treating opioid and alcohol use disorders. It is non-addictive and is not prone to abuse.

Administering Vivitrol

Vivitrol is given as a once-monthly 380 mg intramuscular (IM) injection. Healthcare providers give Vivitrol as an intramuscular injection in the gluteal muscles (buttocks). This monthly injection provides a consistent, effective dose of medication. In turn, this eliminates the need for daily pills. Vivitrol offers a convenient and effective option for long-term recovery.

The injection contains the active ingredient naltrexone, housed in a polylactide-co-glycolide shell. Once injected, the medication lasts for a month and cannot be removed. The injection cannot be given elsewhere on the body.

Vivitrol for Opioid Dependence

The FDA approved Vivitrol for opioid use disorder four years after approving it for alcohol use disorder. Studies showed that patients who received monthly Vivitrol injections had a lower chance of relapsing. They were also more likely to stay in recovery.

Before a patient receives Vivitrol for opioid addiction, their system should be free of opioids. Typically, this will mean waiting at least 7–10 days before their last opioid use. Even opioid agonists used in medication-assisted treatment (e.g., buprenorphine) should be clear from the system. This is because Vivitrol prohibits any type of opioid from binding to the receptors, triggering withdrawal. The opioid withdrawal experienced when Vivitrol is combined with opioids is extremely uncomfortable. 

Vivitrol has been proven to be a safe and effective form of treatment for opioid use disorder. However, people taking Vivitrol should be aware that the treatment may quickly lower their opioid tolerance. If someone returns to using opioids in the same amounts they used to, they risk overdose and other life-threatening conditions.

Vivitrol for Alcohol Use Disorder

Vivitrol is an effective treatment for alcohol dependence. It has been shown to reduce the number of heavy drinking days in patients with alcohol dependence who also received counseling. People who received Vivitrol were also more likely to abstain completely from alcohol than those who received a placebo. 

By binding to endorphin receptors, Vivitrol blocks the physical effects of alcohol consumption. Vivitrol also reduces cravings. If a patient does drink alcohol, they are prone to drinking less than those who are not on Vivitrol. Once someone can stop drinking, Vivitrol is effective at helping them maintain sobriety. 

Who Should Avoid Vivitrol?

Vivitrol is a long-acting medication that must not be used alongside opioid products. People who take opioids alongside Vivitrol will undergo opioid withdrawal. This is because Vivitrol blocks their opioid receptors. 

Anyone who has had an allergic reaction to Vivitrol or its active ingredient, naltrexone, should not use Vivitrol. People with significant liver disease or hepatitis should not use Vivitrol.

Vivitrol Side Effects

Overall, Vivitrol is well tolerated. The side effects of the injectable and oral forms of naltrexone are quite similar. However, the medication does carry some risk of side effects. Some common side effects associated with Vivitrol use are:

• Pain at the injection site
• Tiredness or lethargy (do not operate heavy machinery or drive while taking this medication
• Painful joints and/or muscle cramps
• Insomnia (difficulty sleeping)
• Nausea
• Vomiting
• Headache
• Dizziness

There are also some rare, serious side effects of Vivitrol, including:

• Serious allergic reaction, also called hypersensitivity, may occur directly after injection. Tell your doctor if you experience severe rash, swelling of the face or mouth, trouble breathing, wheezing or chest pain.
• Allergic pneumonia
• Depressed mood
• Injection-site reaction, such as infection or abscess

The active ingredient in Vivitrol, naltrexone, can cause liver damage (hepatotoxicity) in some users. This may not be the case for Vivitrol. However, if signs of liver toxicity do develop, contact your healthcare provider immediately. These symptoms include stomach pain, dark urine and yellowing of the eyes. 

Risk of Opioid Overdose

People taking Vivitrol should be aware of the potential for accidental overdose. Once given an injection of Vivitrol, the medication blocks opioid receptors for one month. An attempt to overcome this blockade by taking large amounts of opioids is highly dangerous. It can lead to serious injury, coma and death.

Another area of concern involves the risk if a person decides to stop taking Vivitrol. Following a month-long treatment of Vivitrol, an individual may be much more sensitive to opioids. This is because their tolerance has likely decreased. This means that a previously tolerated dose may now prove instantly fatal. For this reason, it is important to avoid taking opioids even if you end up stopping Vivitrol.

Vivitrol and Pregnancy

It is not known if Vivitrol is harmful to a pregnant mother or her unborn baby. However, its active ingredient, naltrexone, is harmful. Naltrexone is classified as a Category C medication. This means it has been shown to produce damaging effects in animal studies. As of now, there are no equivalent studies in humans.

Naltrexone use during pregnancy is a delicate matter. Naltrexone has potential in the treatment of opioid-dependent pregnant women. However, its current uses are limited, as little data exists on its safety profile.

Still, it is well-known that illicit opioids like heroin have a direct adverse effect on developing infants. Illicit opioid and alcohol use during pregnancy should be strictly avoided.

If someone becomes pregnant while using naltrexone, they should consult their doctor. They can discuss whether to continue the medication and the advantages and disadvantages of doing so. At least one study has demonstrated a favorable outcome using naltrexone during pregnancy. Naltrexone may provide some heavy users the support needed to ensure an opioid-free pregnancy and a healthy baby.

It is not known whether Vivitrol passes into breast milk. You should discuss breastfeeding while on Vivitrol with your healthcare provider.

It is important to consult your healthcare provider if you become pregnant while taking naltrexone.

Vivitrol Cost

The standard cost for a 380 mg Vivitrol intramuscular injection is $1,639.

Vivitrol Cost

• Does Medicaid Cover Vivitrol?
  Florida Medicaid covers Vivitrol under FFS plans. Patients aged 16 and older are eligible. Variations may occur depending on state regulations. You can see if your state covers it here.  
• What Is the Vivitrol Free Trial Program?
  A co-pay savings program may be offered for eligible patients with a Vivitrol prescription. The program covers up to $500 monthly of co-pay or deductible expenses.  
• Does Insurance Cover Vivitrol?
  Vivitrol is listed on Florida’s preferred drug list under FFS plans through physician services. Individuals should speak with their insurance company or physician for additional eligibility information.  

Vivitrol Effectiveness in Treating Addiction

A clinical review demonstrated an opioid-free rate of 82% with monthly Vivitrol injections. This is compared to a 54% rate in the group taking oral medications. The injection formula provides consistent blood medication levels, offering optimal effectiveness.

Another review found that clients achieved a median 90% abstinence rate from 5–24 weeks. They also had a 50% reduction in cravings after using Vivitrol.

Long-acting naltrexone, the main component of Vivitrol, has been proven to decrease the number of heavy drinking days. In one study, there was a 25% reduction in the number of heavy drinking days in a group that underwent a randomized, double-blind test.

Help for Alcohol Use Disorder

If you or a loved one struggles with alcohol misuse and wants to explore treatment options like Vivitrol, The Recovery Village is here for you. We offer medication-assisted treatment for qualifying patients alcohol and opioid use disorder. Our Recovery Advocates can connect you with support and resources to help you reclaim your life from addiction. Contact us today.