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Vivitrol Misuse: Risks, Symptoms, and Warning Signs

April 18, 2022

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Substance misuse causes a significant burden in the U.S., with annual estimated costs exceeding $600 billion annually.[1] Misuse describes any time that a medication is used other than how and what it was prescribed for.

Naltrexone (Vivitrol) is an FDA-approved injectable medication for alcohol and opioid use disorder treatment. It is an opioid blocker that must be administered by a healthcare provider.[2] 

When supervised by your healthcare provider, the use of naltrexone for the treatment of alcohol or opioid use disorder is typically safe. However, serious consequences such as withdrawal, overdose, and death can occur if the medication is misused. 

What is Injectable Naltrexone (Vivitrol)? 

Injectable naltrexone (Vivitrol) is a non-addicting, non-narcotic, pure opioid antagonist that blocks other opioids from attaching to opioid receptors.[2] It is approved to treat alcohol use disorder and prevent relapse from opioid use disorder (OUD).

The medication is available as an extended-release intramuscular injectable suspension that is administered by a licensed healthcare provider once every four weeks. 

As with all medications, there is the potential for adverse side effects with injectable naltrexone (Vivitrol).[2]

Common Vivitrol side effects include: 

  • Anxiety
  • Headache
  • Insomnia
  • Muscle joint pain 
  • Nausea
  • Sexual dysfunction

Vivitrol must be administered by a healthcare professional due to the risk of serious injection site reactions. You should immediately report any of the following signs/symptoms at any of your injection sites:[2]

  • Any open wounds or a dark scab
  • The area feels hard
  • You feel lumps
  • Blisters
  • Intense pain
  • Large area of swelling

Naltrexone (Vivitrol) for Alcohol and Opioid Use Disorder

Vivitrol is not recommended to be used in people actively drinking and requires a 7 to 14-day opioid detox before treatment can begin.[2]

Before starting Vivitrol, you must be opioid-free regardless of the type of opioid your might be using: methadone, Suboxone, street drugs, etc. This is because Vivitrol can cause sudden withdrawal and require you to be hospitalized if you take opioids within 7 to 14 days of the injection.[2]

You should call 911 or seek emergency medical help immediately if you experience any of the following symptoms:[2] 

  • Difficulty breathing 
  • Excessive drowsiness with slowed breathing 
  • Slow, shallow breathing 
  • Feeling faint, dizzy, confused, or any other overly bothersome or unusual symptoms 

Naltrexone (Vivitrol) Misuse 

Vivitrol is not an appropriate medication for every person with an alcohol or opioid use disorder. 

You should not take Vivitrol if you are: 

  • Experiencing opioid withdrawal symptoms 
  • Allergic to naltrexone or any ingredients in Vivitrol or its diluent 
  • Using or having a physical dependence on opioid-containing medications or street (illegal) drugs 

Before you start Vivitrol, make sure you discuss with your healthcare provider if you: 

  • Are pregnant, plan on becoming pregnant, or are chestfeeding  
  • Have blood disorder or bleeding problems 
  • Suffer from liver or kidney problems 
  • Use or misuse street (illegal) drugs 
  • Have any other medical conditions 

There are potentially serious risks with Vivitrol use, especially if the medication is misused. 

Unlike opioid medications as part of Medication for Addiction Treatment (MAT), Vivitrol is not habit-forming and does not cause a high even when taken with other drugs.

Therefore, Vivitrol is generally considered unlikely to cause dependence. While this may be the case, misusing Vivitrol is still considered dangerous. 

Common Forms of Vivitrol Misuse 

Not stopping opioid use 7 to 14 days before beginning Vivitrol treatment as directed by your healthcare provider is a common way to misuse the medication. This may cause sudden opioid withdrawal, potentially leading to hospitalization.[2]

Continuing opioid use after starting Vivitrol treatment can cause an opioid overdose and death. Even though naltrexone is an opioid blocker, it still has to compete for the receptors. So, if someone were to take a high dosage of an opioid, it could out-compete the naltrexone causing an overdose.[2]

Relapsing during or after Vivitrol treatment and taking the same opioid dose as before (or a higher dose) is another common way to misuse Vivitrol.[2] Some individuals who use or have used Vivitrol report a greater sensitivity to opioids (i.e., decreased tolerance). 

If someone were to relapse and continue using their previous opioid dose or a higher dosage, they could experience an overdose which can lead to death.[3] 

What Is the Risk of Fatal Overdose from Vivitrol Misuse?

The risk associated with injectable naltrexone (Vivitrol) for opioid use disorder has not been well studied.[4] However, data shows that 1 out of 2 people discontinue or stop using Vivitrol after a single dose.

A recent case review study found that the risk of fatal overdose appears to be the highest between 28 to 56 days after the last Vivitrol injection.[4] 

Since this study was a review of previous cases and had a small sample size, more robust research is required to better understand the risk of fatal overdoses from misuse of Vivitrol. 

It is important that people taking Vivitrol let their family members and/or the people closest to them know that they may have an increased sensitivity to opioids and a greater risk of overdose. 

If you or someone close to you suspects an overdose, knowing the right steps can help save their life [5]: 

  • Call 911. 
  • Administer naloxone (Narcan) within 2 – 3 minutes, if available. Remember, naloxone can bind to the opioid receptors and kick off the opioid blocking its effects. This opioid blockade is temporary, so emergency services are still necessary.
  • Keep the person awake and breathing. If necessary, 911 dispatchers can assist with CPR procedures.
  • Lay the person on their side to prevent choking.
  • Stay at the scene until emergency help arrives.

How Bicycle Health Can Help with Opioid Use Disorder

If you or someone you know is struggling to overcome opioid use disorder, reach out to Bicycle Health to find out more about telemedicine treatment options. Call us at (844)943-2514 or schedule an appointment here

Brittany Hoffmann-Eubanks, PharmD, MBA

Brittany Hoffmann-Eubanks, PharmD, MBA, received her Doctor of Pharmacy and Master of Business Administration degrees from Drake University College of Pharmacy and Health Sciences and completed her community pharmacy residency with Midwestern University and a local community pharmacy.

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1. Healthy People 2020. Substance Abuse. Accessed December 9, 2021. 

2. Vivitrol [Naltrexone] Prescribing Information. Alkermes, Inc; 2021. Accessed December 9, 2021.

3. Kjome KL, Moeller FG. Long-acting injectable naltrexone for the management of patients with opioid dependence. Subst Abuse. 2011;5:1-9. doi: 10.4137/SART.S5452. Epub 2011 Feb 6. PMID: 22879745; PMCID: PMC3411517.

4. Saucier R, Wolfe D, Dasgupta N. Review of Case Narratives from Fatal Overdoses Associated with Injectable Naltrexone for Opioid Dependence. Drug Saf. 2018 Oct;41(10):981-988. doi: 10.1007/s40264-018-0653-3. Erratum in: Drug Saf. 2018 May 24;: PMID: 29560596. 

5. Centers for Disease Control and Prevention. Know the Signs. Save a Life. Accessed December 8, 2021. 

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