Alcohol use disorder (AUD) and opioid use disorder (OUD) are the two most common substance use disorders (SUD) in the United States. Before the emergence of COVID-19, the U.S. was already facing a public health crisis with alarming rates of SUDs. According to provisional data from the Centers for Disease Control and Prevention (CDC), around 50,828 Americans died of opioid overdose in 2019, accounting for 70% of all estimated overdose deaths. And excessive alcohol use is responsible for more than 95,000 deaths in the U.S. each year. For this reason, every effort should be made to ensure that individuals with addiction can initiate and maintain treatment even during COVID times.
Vivitrol is an injectable form of naltrexone used to treat alcohol use disorder and opioid dependence. Vivitrol is an FDA-approved medication that helps individuals maintain sobriety by reducing or controlling cravings during the early stages of sobriety. However, Vivitrol is most effective when used as part of a comprehensive treatment program to help reduce the risk of relapse and maintain abstinence while in recovery.
Vivitrol’s main ingredient, naltrexone, is currently the only medication that isn’t classified as a controlled substance. Naltrexone works by blocking the opioid receptors in the brain. In contrast to other medications such as buprenorphine and methadone, Vivitrol is a non-addictive and non-narcotic medication with a low potential for misuse. When used as part of medication for alcohol use disorder (MAUD), Vivitrol prevents the endorphins released by alcohol from binding to their receptors. But when used as a medication for opioid use disorder (MOUD), Vivitrol attaches itself to opioid receptors in the brain and prohibits other opioids from interacting with them.
Individuals in MOUD treatment must complete opioid detoxification and maintain abstinence for seven to 14 days before initiating Vivitrol treatment. Individuals who use Vivitrol while on opioids can experience sudden opioid withdrawal syndrome (SOWS), leading to fatal consequences. However, as a MAUD treatment, Vivitrol can be used by active alcohol users.
It’s important to keep in mind that Vivitrol alone cannot help you achieve prolonged recovery. Vivitrol is just one component of a comprehensive treatment plan that must include counseling and other behavioral therapies so that individuals in recovery are provided a “whole-person” approach to treatment. Clinical studies indicate that Vivitrol combined with counseling and behavioral therapy has shown a 90% success rate in helping people stay in treatment and maintain sobriety.
According to the U.S. Food and Drug Administration (FDA), Vivitrol must be prepared and administered by a healthcare professional as an intramuscular (IM) gluteal injection at the recommended dose of 380 mg each month.
Before initiating Vivitrol treatment, healthcare practitioners must conduct:
Once an individual meets the requirements and conditions, they will be considered eligible for Vivitrol treatment.
Vivitrol is packaged along with a special needle to administer the medication. Your healthcare practitioner will inject the medication into a muscle in one of your buttocks during treatment. For consecutive injections, most healthcare providers alternate between the buttocks and the thighs. Rotating injection sites is a practice that is done solely to reduce the risk of scarring and injection site reactions caused by getting injected in the same area.
Vivitrol can cause severe injection site reactions (ISRs) in certain individuals, some of which may require significant surgical intervention. In addition, the National Center for Biotechnology Information (NCBI) reports that the chance of these severe reactions may increase if the medication is inadvertently administered subcutaneously (under the skin) rather than intramuscularly (deep into the muscles).
Vivitrol is generally well tolerated. However, its common side effect profile is similar to that of oral naltrexone, with the addition of possible injection site reactions.
Common side effects of Vivitrol include:
Inform your healthcare provider if the side effects persist or worsens. Your physician can decrease your dosage or provide you with an alternative medication.
Some of the severe side effects of Vivitrol include:
Severe side effects of Vivitrol have the potential to be a medical emergency that requires immediate medical attention. Hence it’s vital to pay close attention to these symptoms and conditions.
How long Vivitrol remains in your body is determined by how quickly the body breaks down the slow-release formula of Vivitrol, which differs from person to person. The effect of Vivitrol lasts around a month in most people, with new shots required once every month to keep it active.
Vivitrol’s effects peak two hours after the first dose and then peak again after two to three days of treatment. The medication’s concentration in the body begins to diminish two weeks after administration. However, it can be detected for up to 25 to 50 days following initial administration.
Many factors influence how long Vivitrol remains in your system, including:
Since Vivitrol is an ideal treatment option for short-term and long-term treatment, it can be administered for several months or years. However, most medical professionals recommend that Vivitrol be administered for at least a year.
It’s difficult to predict which medication will work best for someone with OUD or AUD. Furthermore, the factors that influence a person’s pharmaceutical treatment success may shift over time or subsequent treatment attempts.
However, the following individuals are considered ideal candidates for Vivitrol treatment:
Experts agree, however, that the following people are unlikely to benefit from Vivitrol:
Vivitrol blocks the effects of any opioid-containing medicines you take, such as prescription medicine for pain, cough, diarrhea medicines, vitamins, and herbal supplements. Harmful side effects may occur as a result of these medications interacting with Vivitrol.
Vivitrol may interact with medications such as:
Inform your health care provider about all opioid-containing medicines you use now and any medicine you have used in the past.
Vivitrol is classified by the U.S. Food and Drug Administration (FDA) as a category C pregnancy medication. The FDA has defined various pregnancy categories that reflect how safe or unsafe a medication is when used during pregnancy. A medicine classed as category A is considered safe during pregnancy, and medications in category B are considered relatively safe. However, category C (the most common classification) is considered unsafe since it causes harm to the fetus. Hence medication in this category should only be taken if the benefits outweigh the risks.
Another concern regarding Vivitrol is how it may affect the baby during breastfeeding. Unfortunately, it’s not clear whether breastfeeding is safe while using Vivitrol since naltrexone is known to pass into breast milk. However, it’s best to consult your doctor and talk to them about any concerns you may have. They can help you figure out the best way to feed your child during Vivitrol treatment.
Ultimately, whether or not Vivitrol is a suitable treatment option during pregnancy is between you and your healthcare provider. A doctor may recommend that you take the monthly injection if the dangers of not using Vivitrol exceed its risks.
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