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What Are the Differences Between Vivitrol (Naltrexone) & Suboxone?

April 18, 2022

Table of Contents

Suboxone is the most commonly prescribed treatment for opioid use disorder (OUD). Suboxone contains both Buprenorphine and Naltrexone. Buprenorphine, a partial opioid agonist, eases withdrawal symptoms and cravings, while naltrexone blocks these effects as an opioid antagonist.

Vivitrol, in contrast, contains Naltrexone only, and can be administered either in an oral (pill) or injectable formulation to help block any euphoria achieved by using opioid drugs and in this way helps to treat OUD.

Opioid use disorder claims thousands of victims every year, but expanded access to Medication for Addiction Treatment (MAT) has helped thousands overcome OUD in recent years.

Suboxone vs. Vivitrol: Important Approaches to MAT

Medications for Addiction Treatment (MAT) has greatly improved over the past several decades, helping thousands of people overcome opioid use disorder (OUD).

Prescribed medications like Suboxone (buprenorphine/naloxone) and Vivitrol (Naltrexone) support physical and emotional stability during opioid withdrawal. One of the greatest achievements of MAT is improving rehab retention rates.

Suboxone and Vivitrol are two of the most prescribed brand-name medicines in MAT, but they are very different medications and prevent opioid use by two different mechanisms.

Suboxone

This sublingual film is taken once per day, releasing buprenorphine into the body by being absorbed under the tongue. Buprenorphine is a partial opioid agonist that binds to receptors in the brain to ease cravings and withdrawal symptoms, and block the effects of other opioids in the event of an overdose.[3] Suboxone also contains naloxone, a fast-acting opioid antagonist that prevents overdose.[4]

Vivitrol

This is an intramuscular injection of Naltrexone, an opioid antagonist, that releases a consistent amount of medication into your bloodstream over the course of one month. Naltrexone is prescribed to overcome alcohol and opioid use disorder, as the antagonist nature of this prescription blocks the euphoric effects of both of these drugs.[1] If a person is on Vivitrol and relapses, abusing opioids or alcohol will not create the same high or pleasure and therefore disincentives use.[2]

The Differences Between Suboxone & Vivitrol

Though both Suboxone and Vivitrol are important forms of MAT, they are very different medications. Here are the few similarities between the two:

  • Both medicines are prescribed to treat opioid use disorders.
  • Both contain an opioid antagonist.
  • Both medications ease cravings.
  • Both block some effects of opioid drugs in the event of a relapse.
  • Neither stops an acute opioid overdose.

There are also important differences, like these:

  • Suboxone contains buprenorphine, a partial opioid agonist, as the active ingredient, while Vivitrol contains naltrexone, a long-acting opioid antagonist.
  • Suboxone is prescribed within a few days after the last dose of an opioid of abuse metabolizes out of the body, and it is designed to physically stabilize the individual. Vivitrol is prescribed after a person is fully abstinent from all opioids, including buprenorphine.
  • Vivitrol Naltrexone can block the effects of Suboxone, therefore they cannot be used together. 
  • Buprenorphine can have some euphoric effects particularly for people who are opioid-naïve, while naltrexone does not cause any euphoria, is not addictive, and has no associated withdrawal symptoms.

Which Is Better for MAT?

For people with OUD, both Suboxone and Vivitrol can be effective; however, the evidence for success rates tends to be a little higher, thus it is usually the first treatment to try before Naltrexone. In a study comparing Suboxone to Vivitrol, researchers found Suboxone to be a more effective substance abuse treatment.[5] 

  • People taking Suboxone had an average of 10 opioid-free days, compared to 4 among those taking Vivitrol.
  • In a 144-day period, people taking Suboxone reported an average of 81 abstinent days, while those taking Vivitrol reported 39 abstinent days.
  • People taking Suboxone were abstinent longer before relapse — 14 weeks compared to Vivitrol’s 8 weeks.

However, for patients who cannot tolerate Suboxone, Naltrexone can be a very good alternative. Some people may take Suboxone for a time until they are quite stable off of opioids and then chose to either continue with Suboxone long term or change to Vivitrol.

Can You Take Suboxone & Vivitrol at the Same Time?

Unfortunately Suboxone and Vivitrol cannot be taken together. Vivitrol binds more strongly to opioid receptors in the brain than Suboxone does. Therefore, taking Vivitrol after taking Suboxone will render the Suboxone ineffective, and worse, may cause precipitated withdrawal symptoms. Thus usually a patient and their doctor will decide to take one or the other at a time as the mainstay of their treatment for OUD. Talk to your doctor about which of these two medications might be right for you.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Homepage. Vivitrol.com. https://www.vivitrol.com/. Accessed January 2022.
  2. Naltrexone. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naltrexone. November 2021.
  3. Homepage. Suboxone.com. https://www.suboxone.com/. Accessed January 2022.
  4. Buprenorphine. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. January 2022. Accessed January 2022.
  5. Comparative Effectiveness of Extended-Release Naltrexone versus Buprenorphine-Naloxone for Opioid Relapse Prevention. The Lancet. https://www.sciencedirect.com/science/article/abs/pii/S014067361732812X. January 2018. Accessed January 2022.
  6. Combined Administration of Buprenorphine and Naltrexone Produces Antidepressant-Like Effects in Mice. Journal of Psychopharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075030/. July 2015. Accessed January 2022.
  7. A Combination of Buprenorphine and Naltrexone Blocks Compulsive Cocaine Intake in Rodents Without Producing Dependence. Science Translational Medicine. https://www.science.org/doi/10.1126/scitranslmed.3003948. August 2012. Accessed January 2022.

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