Vivitrol and Drinking – What You Should Know

Medically Reviewed by
Nzinga Harrison, MD
August 13, 2021

Alcoholism or Alcohol use disorder (AUD) is currently the third leading preventable cause of death in the U.S. According to the 2019 National Survey on Drug Use and Health (NSDUH), 14.5 million Americans aged 12 and older had an alcohol use disorder, including nine million men and 5.5 million women.

Since the emergence of COVID-19, the rate of alcohol use and misuse has worsened. Thus, leading to a long-lasting public health crisis. Given the unique challenges of Covid-19 and the accompanying surge in alcohol use and misuse since then, the necessity for treatment programs that can reach and aid individuals during the pandemic is now more crucial than ever before. 

While some addiction treatment medications are prescribed through an opioid treatment program (OTP), others are provided by trained healthcare practitioners in non-OTP medical clinics. Because of the ease of access and availability, many people can acquire critical medications to aid them in their rehabilitation during the pandemic. 

Vivitrol is one of three medications approved by the U.S. Food and Drug Administration (FDA) for alcohol use disorder. Vivitrol is an injectable form of extended-release naltrexone administered intramuscularly into the buttocks by a healthcare provider once a month in a clinical setting.  Vivitrol is a non-addictive and non-narcotic prescription medication with a low risk of misuse and dependence. Vivitrol is used as part of a comprehensive treatment program to help reduce the risk of relapse and maintain abstinence while in recovery.   

How Does Vivitrol Work?

Vivitrol is an opioid antagonist (inhibitor) that works by blocking the effects of alcohol in the brain and lowering alcohol cravings during withdrawal. Although Vivitrol does not prevent a person from drinking, it does dull the effects of alcohol while on medication. Therefore, this medication helps decrease heavy drinking habits till individuals achieve sobriety.

Unlike disulfiram (Antabuse), which makes you ill when you drink, Vivitrol alters how your brain responds to the alcohol in your system. Vivitrol accomplishes this by preventing alcohol-induced endorphins from attaching to their receptors.

Vivitrol, as a medication for addiction treatment (MAT), takes time as it doesn’t instantly reduce cravings for alcohol. Therefore, it’s critical not to miss any Vivitrol shots to gain the full benefits of this medication. Missing a scheduled injection can dramatically impair the effectiveness of the next dose. 

Vivitrol is most effective when used in conjunction with other elements of a comprehensive treatment program to help individuals in recovery decrease the risk of relapse, reduce cravings, and maintain long-term abstinence. 

Administration of Vivitrol

Vivitrol must be prepared and administered by a healthcare provider in a clinical setting once a month. Vivitrol is typically packaged with a special needle and is only administered with that syringe. 

Each Vivitrol package includes:

  • A diluent for the suspension of Vivitrol microspheres.
  • A vial of Vivitrol microspheres (sterile powder).
  • A prepackaged syringe.
  • Two one-and-a-half-inch 20G administration needles with a clear protective cap.
  • A pair of two-inch 20G administration needles with a clear protective cap.
  • A one-inch 20G preparation needle (not for administration).

During treatment, a healthcare provider will inject a 380-mg dose of the medication into a muscle in one of the buttocks. Most healthcare practitioners rotate between the buttocks and the thighs for consecutive injections. This procedure is known as rotating injection sites and is done with the sole purpose of lowering the risk of scarring and injection site reactions caused by getting injected in the same spot.

Potential Side Effects of Vivitrol

Vivitrol is generally considered safe to use. However, all medications have a list of potentially negative side effects. Although side effects from Vivitrol use are relatively rare, they do occur in some instances.

According to the Food and Drug Administration (FDA), common side effects of Vivitrol include:

  • Dizziness
  • Headache
  • Muscle cramps and muscle aches
  • Stomach cramps
  • Nausea and vomiting
  • Joint pain
  • Tiredness

Inform your doctor immediately if the side effects persist or worsen with time. Your doctor will either reduce your dosage or prescribe an alternative medication.

Other potentially serious side effects of Vivitrol include:

  • Depressed mood
  • Allergic reactions, such as rashes, hives, and facial swelling
  • Liver damage or diseases such as hepatitis or changes in liver function tests
  • Pneumonia
  • Severe injection site reactions 

The majority of injection site reactions are moderate and resolve on their own. However, certain negative reactions, such as tissue death, may necessitate surgery.

Vivitrol-induced depression can sometimes become severe, leading to suicidal behavior and thoughts. As a result, if you’re feeling depressed, hopeless, helpless, or have suicidal or self-harming thoughts, you must seek medical attention immediately.

Can You Drink on Vivitrol?

Individuals who use Vivitrol while drinking alcohol do not experience any substantial risks. However, they may experience:

  • Reduced cravings for alcohol.
  • Be less compelled to drink more alcohol.
  • Few signs of intoxication, such as a lack of motor coordination and judgment.

Furthermore, the use of alcohol in conjunction with Vivitrol will not:

  • Make an individual become more or less intoxicated based on the amount of alcohol they have consumed.
  • Cause the person to feel extremely ill in the same way that disulfiram does.
  • Reduce the negative effects of alcohol use in the short term (unless the individual drinks less alcohol due to Vivitrol).
  • Reduce the long-term effects of chronic alcohol misuse, such as liver damage, cardiovascular damage, kidney damage, and an increased chance of neurological disorders including stroke, seizures, or even dementia (unless Vivitrol results in the individual drinking significantly less alcohol over time).

Vivitrol aids in reducing heavy drinking and the encouragement of sobriety in those who continue to drink. On the other hand, its effectiveness is substantially higher in individuals who can abstain from alcohol for 4-7 days before starting treatment.

Alternative Medication for Alcoholism

Each person’s unique requirements and conditions determine if Vivitrol is the best treatment for their alcohol use disorder. If your doctor has prescribed this medication, they believe it will help you recover more quickly. However, It’s crucial to remember that Vivitrol isn’t the only medication for AUD.

There are currently three medications on the market approved by the FDA for the treatment of AUD:

  • Antabuse (disulfiram)
  • Campral (Acamprosate)
  • Naltrexone

Among the three medications approved by the FDA to treat AUD, Antabuse is the only medication that causes a high sensitivity to ethanol in alcohol. As a result, Antabuse is only prescribed to people who have completed their detox. However, this is not the case with Campral and naltrexone for alcohol use disorder. These medications aren’t intended to make a person stop drinking by causing negative side effects. 

While all of these medications have been shown to help reduce drinking, cravings, the likelihood of a relapse, their effectiveness in achieving and maintaining abstinence is only increased when these medications are used in conjunction with other elements of a rehabilitation program.

The Ideal Candidate for Vivitrol Treatment

Vivitrol is most effective in individuals who are strongly motivated to stop drinking. Healthcare practitioners run a few tests before a Vivitrol treatment to screen an individual for liver disease and any signs of allergic reactions to naltrexone, polylactide-co-glycolide (PLG), carboxymethylcellulose, and other Vivitrol ingredients. A person is only considered eligible for a Vivitrol shot if they meet all of the criteria and conditions. 

Vivitrol is safe and effective for both short and long-term usage, which is beneficial since people can use it for as little or as long as they need depending on their treatment goals. While some people will continue to take Vivitrol injections for a long time, others may only need it for a few months. However, most medical professionals recommend that Vivitrol be administered for at least one year for a better outcome.

While Vivitrol is an effective medication for addiction treatment, it’s not an ideal treatment option for everyone. Therefore, Vivitrol should not be taken by anyone who is:

  • Physically dependent on opioid medications. 
  • Allergic to ingredients used in Vivitrol injection.
  • Diagnosed with severe liver disease or hepatitis. 

A healthcare provider may test you for opioid dependence before Vivitrol treatment to mitigate the risk of sudden opioid withdrawal syndrome (SOWS). This test is conducted by administering a low-dose Vivitrol injection to determine if a person has any physical dependence on opioid-containing medications. This test is called a naloxone challenge test. Individuals will not be prescribed Vivitrol if they experience opioid withdrawal symptoms after the test. However, they may be eligible for Vivitrol treatment after an opioid-free period of 7-14 days before Vivitrol treatment and remain opioid-free after treatment.

Vivitrol combined with counseling and therapy has a 90% success rate in helping people achieve sobriety. While Vivitrol is still the treatment of choice for many people suffering from alcohol addiction and opioid dependence, it’s vital to assess the potential risks and benefits and seek medical counsel before taking this monthly injection.

If you are seeking help with your loved one’s addiction, contact us today or complete our quick contact form below, to speak with an addiction treatment specialist.

If you need help with your substance use disorder, we are here to help you build your confidence and momentum towards the future you want. We provide treatment services for adults with alcohol, opioid, and other substance use disorders. We are currently located in Florida, LouisianaMassachusettsNew JerseyNorth CarolinaOhio, Texas, and Washington.

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Nzinga Harrison, MD

Dr. Harrison serves as the Chief Medical Officer for Eleanor Health with more than 15 years experience practicing medicine. She is a double-board certified physician with specialties in general adult psychiatry and addiction medicine. Dr. Harrison has spent her career as a physician treating individuals from marginalized communities with substance use and other psychiatric disorders. As a physician executive, she has served as Senior Vice President and Chief Medical Officer roles committed to creating and improving systems-based delivery of psychiatric and substance abuse care. She is a vocal advocate for stigma reduction, and is passionate about the necessity for whole-person care as individuals and communities seek to recover from and prevent substance use disorders.

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