Suboxone vs. Vivitrol: Which Is Better for Treating OUD?

January 2, 2023

Table of Contents

Suboxone and Vivitrol are two medications that are commonly prescribed to patients with opioid use disorder (OUD). Both help prevent relapse. However, the two medications differ in several ways, including how they are administered, how they act in the body, and the side effects they have.

What is Suboxone?

Suboxone is a brand-name medication that is approved by the U.S. Food and Drug Administration (FDA) for the treatment of OUD. It contains two drugs — Buprenorphine and Naloxone. When taken appropriately and dissolved under the tongue, the Naloxone component disintegrates and the individual only ingests the Buprenorphine component, which is the active ingredient that treats OUD. 

Buprenorphine is a partial opioid agonist that binds to opioid receptors but activates them less strongly compared to a full agonist like oxycodone, heroin or fentanyl. It alleviates withdrawal symptoms and drug cravings without causing euphoria or a “high”.[1] 

In other words, if someone is on Suboxone and takes an opioid, they will not feel its effects. In this way, Suboxone can be protective against overdose. [2]

Suboxone is available in two formulations — as a sublingual tablet and a sublingual film. Both formulations dissolve within 15 minutes of being placed under the tongue or between the cheek and gums. 

Suboxone Side Effects

Suboxone is a controlled medication that is generally quite safe to consume, but it does have side effects which may include[3]:  

  • Headache
  • Stomach pain
  • Vomiting and nausea
  • Constipation
  • Insomnia
  • Swollen arms and legs
  • Sensation loss in the mouth

These symptoms are mild in most individuals and tend to abate after a day or two one the body gets accustomed to the medication. Patients struggling with OUD should begin Suboxone only under the supervision of a healthcare practitioner. This is because Suboxone can precipitate withdrawal when taken while there are opioids in the bloodstream. 

What is Vivitrol?

Vivitrol is another FDA-approved medicine for OUD and additionally alcohol use disorder. It contains an opioid antagonist called naltrexone — similar to naloxone which is found in Suboxone. 

Unlike Suboxone, which contains buprenorphine, Vivitrol does not have an agonist component. As a result, it will not relieve withdrawal symptoms or prevent cravings in the same way that Suboxone dose. 

The purpose of naltrexone in Vivitrol is to block opioid receptors. This has several beneficial effects: 

  • If someone uses an illicit opioid, they will not experience euphoria or be able to get high 
  • There is a lower risk of overdose if a person relapses with Vivitrol in their system. 

Unlike with Methadone or Suboxone, Vivitrol does not cause any dependence or have any addiction potential. Patients who stop taking Vivitrol will not feel any withdrawal symptoms. 

Vivitrol is administered as an injectable in the gluteal muscle. It stays in the system for one month and regular monthly shots are needed for it to maintain its efficacy. 

Vivitrol injections should only be performed by a healthcare provider. 

Vivitrol Side Effects

Similar to Suboxone, Vivitrol is also known to cause side effects which may include[4]: 

  • Nausea
  • Headache
  • Dizziness
  • Anxiety, nervousness, restlessness, and irritability
  • Lack of appetite but increased thirst,
  • Muscle or joint aches
  • Weakness
  • Sleep issues (insomnia)
  • Diminished sex drive, impotence, or difficulties achieving an orgasm

Patients who are planning to start treatment with Vivitrol must be opioid-free for a few days before taking their first dose. Otherwise, they may experience abrupt opioid withdrawal known as "acute abstinence syndrome" or "precipitated withdrawal.”[5] 

Suboxone vs. Vivitrol Comparison

Both Suboxone and Vivitrol are proven and effective Medication-assisted Treatment (MAT) options for OUD. While similar in their effectiveness in treating OUD, the two medications have several differences that might make one more appealing than the other for a given individual.

Suboxone Vivitrol
What does it do? Partial opioid agonist; Decreases physical withdrawal symptoms and reduces opioid cravings Opioid antagonist; Prevents overdose and any “euphoria” from opioid use, which disincentivizes use
Common side effects Headache, stomach pain, vomiting, dizziness Headache, nausea, dizziness, anxiety, restlessness, nervousness, muscle aches
Misuse potential moderate Low/none
How is it taken? Orally in a daily dose Monthly in an injection

1. Mechanism of Action 

Suboxone and Vivitrol are FDA-approved medicines for treating OUD. Both drugs reduce opioid use, but Suboxone does so by actually reducing cravings and preventing withdrawal symptoms. In contrast, Naltrexone only helps to prevent overdose and block “euphoria” if a person subsequently attempts to misuse opioids. However, Vivitrol does not actually reduce cravings or address physical side effects from withdrawal. For this reason, these days it is often considered a second line option for OUD as compared to Suboxone or Methadone. 

2. Abuse Potential

One advantage to Vivitrol is that it does not cause physical dependence and does not cause any euphoria or “high”. Therefore it has no abuse potential. 

Suboxone still has a relatively low misuse potential, especially compared to other full opioid agonists. However, it does still contain an opioid and can cause some euphoric effects/physical dependence, and therefore does carry some, albeit comparatively low, risk of misuse. 

One mechanism to increase Suboxone’s safety is the inclusion of Naloxone, which prevents an individual from getting high or experiencing euphoria if they attempt to misuse the medication by injecting it. In spite of this, there is some dependency and a low risk of misuse, as compared to Vivitrol which has essentially no misuse potential and no physical dependency. 

3. Dosing/Administration Differences 

Suboxone is taken once a day in a single dose. It exists in four dosage forms, each with a buprenorphine-to-naloxone ratio of 4:1:

  • 2 mg buprenorphine / 0.5 mg naloxone
  • 4 mg buprenorphine / 1 mg naloxone
  • 8 mg buprenorphine / 2 mg naloxone
  • 12 mg buprenorphine / 3 mg naloxone

On the other hand, Vivitrol is administered once a month in a fixed dose of 380 mg delivered intramuscularly.

Learn More About Bicycle Health

Curious to find out whether Suboxone or an alternative OUD treatment is right for you? Book an enrollment call or call us at (844)943-2514 to learn more.

Medically Reviewed By 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.

Reviewed By

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Citations

  1. Kumar R, Viswanath O, Saadabadi A. Buprenorphine. In: StatPearls. StatPearls Publishing; 2021. Accessed September 24, 2021. http://www.ncbi.nlm.nih.gov/books/NBK459126/
  2. Jordan MR, Morrisonponce D. Naloxone. In: StatPearls. StatPearls Publishing; 2021. Accessed October 12, 2021. http://www.ncbi.nlm.nih.gov/books/NBK441910/
  3. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.
  4. Ndegwa S, Pant S, Pohar S, Mierzwinski-Urban M. Injectable Extended-Release Naltrexone to Treat Opioid Use Disorder. In: CADTH Issues in Emerging Health Technologies. Canadian Agency for Drugs and Technologies in Health; 2016. Accessed October 12, 2021. http://www.ncbi.nlm.nih.gov/books/NBK481477/
  5. Hassanian-Moghaddam H, Afzali S, Pooya A. Withdrawal syndrome caused by naltrexone in opioid abusers. Hum Exp Toxicol. 2014;33(6):561-567. doi:10.1177/0960327112450901

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