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January 11, 2019

How Does Vivitrol Work

Vivitrol is the newer, brand-name and injectable version of the drug naltrexone. Naltrexone itself has been around for years as a treatment for opiate use disorders (since 1984), and more recently (since 1994) for alcohol use disorders.

Since its approval by the Food and Drug Administration (FDA) in 2010, Vivitrol has helped many people in early recovery from opiates and/or alcohol overcome their cravings, and is a viable treatment option for anyone thinking about rehab. In fact, Vivitrol in combination with therapy is often a “first-line approach” in treating some addictions, according to a 2015 Boston Globe article. How, then, does Vivitrol work? This article will answer that question, so that you can determine whether Vivitrol, in combination with a rehab program, may be worth discussing with your doctor.

How Vivitrol Works

Like naltrexone, Vivitrol binds to the brain’s opiate receptors— the same sites to which alcohol and opiate drugs like prescription painkillers and heroin bind, producing their pleasurable and addictive “high” in the form of a dopamine surge. This artificial stimulation of the brain’s pleasure and reward circuit is what over time produces physical addiction and the cravings that describe it. These cravings are strongest during early recovery after detox, because the brain’s opiate receptors are still accustomed to the euphoric hyperstimulation that alcohol or opiates provided them.

Vivitrol, an opiate receptor “antagonist,” works by blocking these same receptors, essentially binding to them but without the corresponding flood of dopamine. In this way, the medication diminishes cravings, and—in the case of a relapse—can significantly reduce the pleasure of drinking or using opiate drugs.

A Vivitrol injection at a recommended dose of 380 mg should last for roughly one month (28 days). For that reason, the drug is supposed to be administered once every four weeks.

Vivitrol will also be more effective at supporting the goal of long-term abstinence and recovery when it belongs to a comprehensive plan of treatment that includes evidence-based therapies for addiction. In fact, when administered during the first weeks of recovery, the medication serves to relieve cravings and their otherwise fierce, daily onslaught, so that recovering addicts can better focus on their goals in counseling and therapy. Typically, then, Vivitrol is administered for a period of no more than a year and can be stopped easily, unlike other medication-assisted treatments (MATs) that require a more gradual tapering.

Why Vivitrol May Be Better Than Naltrexone for Some People

Research has found that while naltrexone can reduce cravings and relapse rates, that effectiveness can be compromised because of patients’ poor compliance with the requirement that they take the medication daily. In contrast, longer acting forms of naltrexone (like Vivitrol) improve clinical outcomes precisely because they overcome the hurdle of treatment non-compliance, the same research has found. One consideration, then, for anyone considering naltrexone for alcohol or opiate dependence should be whether a daily oral form of the medicine or once-monthly, injectable version is more conducive to their lifestyle. While the once-monthly injection (Vivitrol) seems easier to take for many people, some people may actually prefer taking a daily pill.

Vivitrol for Opiate Addiction

A number of studies have looked at the effectiveness of Vivitrol for reducing opiate cravings. In one clinical trial, researchers followed 250 Russian addicts from July 2008 through October 2009, and found that 90 percent of those on Vivitrol were abstinent for 19 weeks, compared to 36 percent of those on a placebo. The conclusion: that Vivitrol had an anti-craving and anti-relapse effect, meaning that people who slipped up were able to return to recovery without falling into a full-blown relapse. (These findings were published in a 2011 article in the journal Lancet.)

More recently, in the largest study yet comparing the once-monthly injection Vivitrol to the daily pill Suboxone (buprenorphine and naloxone), Vivitrol was found to be as effective as Suboxone in decreasing relapse rates. The study, funded by the National Institute on Drug Abuse (NIDA), found that roughly half of people who took either drug remained relapse-free six months later.

In the wake of these findings, NIDA Director Dr. Nora Volkow cited the “widespread belief” that patients “don’t do as well on naltrexone as they do on buprenorphine,” adding, “We’re hopeful this changes the prejudice.”

But a 2017 article in Stat went on to point out a “major caveat” about the study’s results: that participants had to wean themselves off of opiates over a period of three days prior to beginning Vivitrol, in order to avoid sudden symptoms of opiate withdrawal. That prerequisite for treatment reportedly proved too hard to meet for a large number of people, with the result that patients failed to start Vivitrol at a rate that was reportedly four times more than that for Suboxone.

Vivitrol for Alcohol Dependence

Vivitrol is also used as a treatment for alcohol cravings during early recovery, based on a substantial body of research documenting its efficacy at improving recovery outcomes. The long-acting naltrexone injection was originally approved to treat alcohol dependence after the medication was evidenced to reduce drinking frequency and the prospects of relapse to heavy drinking.

In a later study of veterans who were diagnosed as “actively drinking alcohol-dependent,” researchers found that Vivitrol in combination with counseling decreased the rate of heavy drinking in this population by 25 percent. (The findings were published in 2005 in Journal of the American Medical Association.)

Elsewhere, there is strong evidence to support the use of naltrexone in treating alcohol use disorders. The Substance Abuse and Mental Health Services Administration has provided a detailed review of these findings from 14 randomized clinical trials. They reveal that:

  • Patients who could not control their drinking were able to drink lower quantities less often, thanks to naltrexone.
  • Patients saw a reduction in their urge to drink.
  • Naltrexone not only reduced overall relapse rates but significantly prolonged relapse-free time in patients who did eventually relapse.

Such findings notwithstanding, some addiction experts believe Vivitrol is more effective at treating opiate use disorders than it is at treating alcohol dependence. When it binds to opiate receptors in the brain, Vivitrol totally covers those receptors, fully blocking the effects of opiate drugs. Opiate drugs therefore have no way of unleashing their pleasurable effects. Alcohol, in contrast, is thought to work on many receptors in the brain, not just opiate receptors. Vivitrol’s benefits may therefore be more limited in treating alcohol cravings and heavy drinking.

How Vivitrol Is Meant to Be Taken

Treatment with Vivitrol should always be in conjunction with behavioral therapies that address the roots of an opiate and/or alcohol addiction. Research has revealed that Vivitrol’s effectiveness may be enhanced by certain therapies in particular:

  • Coping skills therapy that emphasizes strategies for relapse prevention
  • Abstinence-based group therapy that emphasizes motivational enhanced, relapse prevention and medication compliance

Patients who intend to take Vivitrol for opiate use disorders must undergo a complete opiate detox before starting Vivitrol. The same is largely true for patients with alcohol use disorders who intend to take Vivitrol, although it may not always be necessary to have completed an alcohol detox before starting Vivitrol. (As a general rule, patients should not be drinking when they begin Vivitrol.)

In patients who are in recovery from opiates, starting Vivitrol prematurely following opiate detox can trigger acute abstinence syndrome, an exacerbated experience of opiate withdrawal. For this reason, patients should be opiate-free ideally for 7-10 days.

Only a doctor who is qualified to administer Vivitrol can administer the medication, which should be injected in the gluteal region— and only with the needles that come with the product. Vivitrol should not be injected using any other needle.

Side Effects of Vivitrol

Some of the more common side effects of Vivitrol, as reported by the American Association for the Treatment of Opioid Dependence, can include:

  • Pain at the site of the injection
  • Nasopharyngitis (swelling of the nasal passages and back of the throat)
  • Insomnia
  • Toothache
  • Nausea
  • Vomiting
  • Headache
  • Fatigue
  • Mild to moderate muscle cramps

More serious side effects, occurring in five percent of patients:

  • Depression
  • Suicidal thoughts
  • Dysphoria

Some serious allergic reactions have been reported, including skin rash, facial or tongue swelling, respiratory difficulties, wheezing, chest pain, dizziness and feeling faint.

There have been some rare occurrences of severe allergic pneumonia.

As one of a number of MATS that are used to relieve alcohol and opiate cravings, Vivitrol may be right for you. If you’re struggling with an alcohol or opiate problem, talk to your doctor— or, better yet, contact a trusted rehab provider about your treatment options and whether Vivitrol may be the best MAT to include in your plan of treatment.

For more information related to Vivitrol, see the following articles:

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