Suboxone and Vivitrol are two similar medications that are commonly prescribed to patients who struggle with opioid use disorder (OUD). Both help prevent relapse by reducing opioid cravings and withdrawal symptoms. However, the two medications differ in several ways, including how they are administered.
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 main drugs — buprenorphine and naloxone. When combined, they help decrease the intensity of withdrawal symptoms and reduce opioid dependency.
Buprenorphine is a partial opioid agonist that binds to opioid receptors but activates them less strongly compared to a full agonist. It alleviates withdrawal symptoms and drug cravings without euphoria. At higher doses, buprenorphine blocks opioid receptors which also reduces overdose risk and inhibits the euphoric effects of other opioids.
In other words, if someone is on Suboxone and takes an opioid, they will not feel its effects. To prevent buprenorphine misuse, an opioid antagonist naloxone is also added to the formulation.
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. However, the film/strip dissolves faster and is more expensive compared to the tablet. Both formulations have a distinct taste and patients might choose one over the other based on personal preference.
Suboxone Side Effects
Suboxone is a controlled medication that is safe to consume, but it does cause minor side effects which may include:
- Stomach pain
- Vomiting and nausea
- Swollen arms and legs
- Sensation loss in the mouth
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 an FDA-licensed medicine that is prescribed to patients who struggle with OUD and 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.
The purpose of naltrexone in Vivitrol is to block opioid receptors. This has several beneficial effects:
- It reduces opioid cravings.
- If someone uses an illicit opioid, they will not experience euphoria.
- There is a lower risk of overdose if a person relapses with Vivitrol in their system.
With Vivitrol, there is also no risk of dependence or addiction to the medication. Patients who stop taking Vivitrol will not feel any withdrawal symptoms.
The medication 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:
- Anxiety, nervousness, restlessness, and irritability
- Lack of appetite but increased thirst,
- Muscle or joint aches
- 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 at least 7 to 10 days before taking their first dose. Otherwise, they may experience abrupt opioid withdrawal known as "acute abstinence syndrome" or "precipitated withdrawal.”
It is also important to be aware that Vivitrol is associated with additional risks. If someone suddenly stops using Vivitrol and resumes consuming illicit opioids, they are at a higher risk of overdose, especially around two months after their last shot. This is because Vivitrol removes the tolerance that people develop from frequent opioid consumption.
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.
Suboxone and Vivitrol are FDA-approved medicines for treating OUD. Both drugs reduce cravings for opioids, but only Suboxone can alleviate withdrawal symptoms. This is because naltrexone, the main ingredient in Vivitrol, is an opioid antagonist and not an agonist. In other words, it cannot stimulate opioid receptors in the absence of opioids nor can it reduce withdrawal symptoms.
2. Abuse Potential
Both drugs have low abuse potential, but the risk of abusing Vivitrol is even lower compared to Suboxone.
Suboxone is safe because it contains naloxone, which minimizes the risk of buprenorphine abuse. However, there is still some opioid agonist activity in Suboxone. When combined with benzodiazepines, it can increase the risk of dangerous overdose and people sometimes develop cravings for Suboxone.
Vivitrol has virtually no potential for misuse. For one, it is an opioid antagonist and induces no euphoria when consumed. In addition to that, Vivitrol can only be administered under professional supervision.
3. Dosage 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.
4. Formulations and Administration
Suboxone comes in two sublingual forms — film and tablet. Both formulations dissolve when placed on the inside of the cheek or beneath the tongue. Since Suboxone is available in sublingual formulations, patients can take it at home.
Vivitrol is only available as an intramuscular injection. Patients cannot administer the medication themselves but will need to go to a healthcare provider for their monthly shot.
5. Forms (Brand vs. Generic)
There are currently no available generic forms of Vivitrol. However, Sandoz and Alvogen are two companies that produce FDA-approved generic Suboxone.