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Vivitrol Injections for Alcohol: How Does it Work?

Vivitrol is an FDA-approved intramuscular injection of the pharmaceutical drug naltrexone. It is used for the treatment of alcoholism and drug abuse after an initial detoxification period.

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Naltrexone is different from other medications used to treat alcohol dependence, such as disulfiram. It works by blocking opioid receptors in the brain, which decreases the desire to drink alcohol.

Vivitrol is classified as an opioid antagonist. It is used as part of a comprehensive alcohol addiction treatment and drug recovery programs. It should not be taken by anybody currently using opioids, including methadone. This may cause opioid withdrawal symptoms to occur.

Does Vivitrol Work for Alcohol Addiction?

Vivitrol is an effective treatment for alcohol abuse and alcohol use disorder. A recent study by the National Institute on Drug Abuse found that a monthly Vivitrol shot is as effective as a daily pill of buprenorphine and naloxone, which has well-proven efficacy. 

Vivitrol is effective because of how it affects the brain. Blocking opioid receptors negates the reward-based feelings that accompany drinking. Other treatments, such as Acamprosate, are designed to promote alcohol abstinence through adverse side effects. 

Vivitrol is different. It is intended to limit the ability of alcohol to reach the reward centers of the brain. 

Clinical evidence suggests that Vivitrol is more effective in diminishing heavy drinking among men than women. This may be due to the nature of the injections. Vivitrol is better absorbed intramuscularly (inside muscle tissue) than subcutaneously (inside fatty tissue). Men tend to be able to take on more intramuscular medication than women, on average.  

Regardless of sex or gender, Vivitrol works best when administered as part of a more extensive rehab program or treatment plan. 

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Side Effects of Vivitrol Injections

Many patients that take Vivitrol injections do not experience any side effects. However, Vivitrol can cause unpleasant and potentially serious physical reactions for some users, including:

  • Headache
  • Nausea and diarrhea
  • Stomach pain
  • Chest pain
  • Muscle cramps
  • Flu-like symptoms
  • Weakness
  • Epidermal irritation at the injection site
  • Liver damage

Vivitrol can also cause neurological side effects, such as:

  • Dizziness
  • Nervousness or restlessness
  • Irritability
  • Drowsiness
  • Insomnia
  • Decreased appetite

If patients have traces of opiate recovery medications in their system, there is also a chance of developing severe withdrawal symptoms. A healthcare provider should be notified immediately if any of the following occur:

  • Hallucinations
  • Blurred vision
  • Anxiety
  • Confusion
  • Severe vomiting and diarrhea

Dangers of Drinking Alcohol on Vivitrol 

According to the FDA and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there appears to be no significant dangers or interactions associated with drinking alcohol while taking Vivitrol. However, if Vivitrol is being used to treat alcohol use disorder (AUD), then the patient being treated should not drink alcohol. It is important to start Vivitrol only after drinking has stopped for several days.

The FDA only approves the use of Vivitrol for people who have stopped drinking alcohol and those who are able to not drink alcohol during outpatient treatment. The FDA and NIAAA state that drinking alcohol while taking Vivitrol will not:

  • Alter intoxication based on the amount of alcohol ingested
  • Alter or increase the regular effects of alcohol usage
  • Cause acute illness (unlike disulfiram, which blocks alcohol metabolism and causes nausea, vomiting, headaches, and other symptoms)
  • Increase any long-term effects associated with chronic alcohol abuse
  • Increase any cognitive issues
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Who Should Not Take Vivitrol?

Vivitrol is commonly used in a substance abuse treatment plan. However, the Food and Drug Administration (FDA) has determined that some patients are not deemed qualified to receive Vivitrol. They include:

  • People with allergic reactions to naltrexone or any of Vivitrol’s components.
  • People with opioid dependence. These are patients who have a physical dependence or are presently using medicines containing opioids and opioid drugs such as heroin. Taking Vivitrol while opioid is still present in the system will cause the patient to experience withdrawal symptoms.
  • People exhibiting symptoms of opioid withdrawal

Healthcare professionals typically recognize the most common symptoms of opioid withdrawal symptoms as:

  • Diarrhea
  • Fever
  • Goosebumps
  • Hot flashes
  • Muscle aches
  • Nausea 
  • Restlessness
  • Runny nose
  • Sleeplessness
  • Spasms
  • Stomach cramps
  • Sweating
  • Teary eyes
  • Twitches
  • Vomiting
  • Yawning

Vivitrol Precautions

Vivitrol is generally considered safe when used according to a doctor’s prescription and under the supervision of a health care provider. However, certain precautions must be kept in mind. These include:

  • Tell your prescribing doctor about your allergy history. Vivitrol may contain inactive ingredients that can trigger a severe allergic reaction.
  • Before using Vivitrol, tell your doctor of your medical history. Your doctor should know if you have recent or current use of any opioid drug, liver problems, kidney disease, and bleeding problems. 
  • Some of Vivitrol’s side effects are dizziness, drowsiness, decreased response time, and poor coordination. You should avoid driving, operating heavy machinery, or doing any activity that requires alertness.
  • Inform your doctor and dentist that you are taking Vivitrol before undergoing any form of medical or dental treatment.
  • If you’re pregnant or suspect to be pregnant, talk to your doctor and discuss the pros and cons before starting Vivitrol.

Even though Vivitrol’s abuse potential is low and not known to be addictive, do not use Vivitrol unless prescribed by a doctor. Taking naltrexone without professional medical advice may do you more harm than good.

Resources

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Rounsaville, B.J.; O’Malley, S.; and O’Connor, P. “Guidelines for the Use of Naltrexone in the Treatment of Alcoholism.” New Haven, CT: APT Foundation https://pubs.niaaa.nih.gov/publications/combine/faqs.htm

NIAAA. “Helping Patients Who Drink Too Much: A Clinician’s Guide.” National Institute on Alcohol Abuse and Alcoholism. NIH Publication 07–3769 https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/PrescribingMeds.pdf

Johnson, Bankole A. “Naltrexone long-acting formulation in the treatment of alcohol dependence.” Therapeutics and clinical risk management vol. 3,5 (2007): 741-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376083/

Syed, Y.Y., Keating, G.M. Extended-Release Intramuscular Naltrexone (VIVITROL®): A Review of Its Use in the Prevention of Relapse to Opioid Dependence in Detoxified Patients. CNS Drugs 27, 851–861 (2013). https://doi.org/10.1007/s40263-013-0110-x https://link.springer.com/article/10.1007%2Fs40263-013-0110-x

Rieckmann, T., et al. "The Vivitrol pilot program (VPP): initial quantitative findings from an extended-release naltrexone study." Addict Sci Clin Pract 10, A54 (2015). https://doi.org/10.1186/1940-0640-10-S1-A54 https://link.springer.com/article/10.1186/1940-0640-10-S1-A54

Haglund, Margaret et al. "Vivitrol and Depression, Addictive Disorders & Their Treatment" Sep 2014, Vol 13.  p 147-150 doi: 10.1097/ADT.0000000000000051 https://journals.lww.com/addictiondisorders/Abstract/2014/09000/Vivitrol_and_Depression__A_Case_Report_and_Review.7.aspx

Johnson, Bankole A. “Naltrexone long-acting formulation in the treatment of alcohol dependence.” Therapeutics and clinical risk management vol. 3,5 (2007): 741-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376083/

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