Both Suboxone and Vivitrol are beneficial prescription medications that can help people overcome substance use disorders, most often opioid use disorder (OUD).
Suboxone eases withdrawal symptoms during the first few days the individual abstains from opioids, and also serves to reduce cravings and relapse as they continue on the medication. Vivitrol is also a maintenance medication, reducing cravings and reducing the impulse to use opioids. Because it is a full blocker at the opioid receptor, if someone uses opioids while one it, they will not experience a high, and they will be at low risk of overdose.
What Is Suboxone?
Suboxone is prescribed to people overcoming OUD used as both a maintenance medication and an aid to ease opioid withdrawal symptoms.
The main ingredient in Suboxone is buprenorphine, which is a partial opioid agonist that stays active in the brain for several hours after a dose is taken. This reduces cravings and withdrawal symptoms without causing intoxication.
Suboxone also contains naloxone, a medication originally designed to temporarily stop opioid overdoses. Naloxone prevents Suboxone from being used to get high, as it becomes active if the drug is tampered with.
When taken as medically directed, Suboxone has a lower risk of abuse than other opioids and little overdose potential. This is because it contains buprenorphine, which is only a weak activator, or partial agonist, at the opioid receptors in the brain.
What Is Vivitrol?
Vivitrol is also a maintenance medication, prescribed to people overcoming either OUD or alcohol use disorder (AUD) after they have stopped consuming alcohol or opioids completely.
Vivitrol’s active ingredient is naltrexone, which blocks the intoxicating, euphoric and sedative properties of both alcohol and opioids. The medication binds to opioid receptors in the brain, like buprenorphine or naloxone, suppressing cravings.
A person must be abstinent from opioids for 7 to 14 days before beginning Vivitrol. For Suboxone, less abstinence time, around 72 hours is needed, but sometimes as little as 12 hours. This is because either medication will displace any opioids that are in the system from the opioid receptor, and trigger withdrawal symptoms. However, since Suboxone is not a full opioid receptor blocker, a shorter time of abstinence from opioids is required. Neither Suboxone nor Vivitrol should be initiated without consultation with and under the supervision of a medical provider.
What Do They Do & How Do They Work?
Suboxone is a combination of medications, while Vivitrol is the brand name for one active ingredient, naltrexone. Both Vivitrol and Suboxone contain opioid antagonists, naloxone and naltrexone. Suboxone also contains a partial opioid agonist, buprenorphine. Both are important prescription medicines that help people overcome substance use disorders, but they work in different ways.
- Suboxone: This medication is designed specifically to help people who want to stop abusing opioid drugs like heroin, fentanyl, oxycodone, or codeine. There are two active ingredients in Suboxone: buprenorphine and naloxone.
Buprenorphine is the most important ingredient in Suboxone, as it binds to the brain’s opioid receptors and reduces craving and relapse, in addition to reversing withdrawal in the first days it is taken. Buprenorphine is not an opioid, but it is a partial opioid agonist, so it does have some analgesic and sedative effects in people who have not taken opioids before. However, because it is a weak agonist, buprenorphine usually does not cause intoxication.
Taking a maintenance medication that reduces craving and the impulse to use opioids gives the individual a chance to focus on other aspects of the recovery process, like learning to cope with strong emotions and healthy behaviors in counseling and group therapy. As a result, Suboxone treatment results in lower relapse rates and better chances of long-term recovery.
Previous formulations of buprenorphine, like Subutex, became drugs of abuse as people attempted to get high on their MAT prescriptions by taking it in ways that were not indicated and dangerous, like through snorting or injecting. To prevent this behavior, Suboxone manufacturers added naloxone in the event of tampering.
On its own, naloxone is used emergently to temporarily reverse an opioid overdose, giving time for the person to get lifesaving medical treatment.
Because of the added naloxone, Suboxone is not usually a medication of abuse. If it is tampered with or consumed in a manner other than under the tongue, as prescribed, , naloxone binds to opioid receptors in the brain and can cause uncomfortable withdrawal symptoms. This means that Suboxone is an ideal medication for the long-term treatment of opioid use disorder.
- Vivitrol: This medication is an extended-release, brand-name formula of naltrexone, which is an opioid receptor blocker, or antagonist.
The drug is given as an intramuscular injection every four weeks, and it can bind to and block opioid receptors in the brain for up to one month, reducing the euphoria that would ensue were the person to consume alcohol or opioids.
Since naltrexone binds to the brain’s opioid receptors and blocks them, alcohol and opioid chemicals cannot bind to these sites. As a result, consuming these drugs does not create the same intense sensations of euphoria. It also blocks the usual feelings of sedation and sleepiness from these drug. Importantly, it reduces overdose potential from opioid abuse through this mechanism as well.
For people who have stopped abusing alcohol or opioids , Vivitrol can help to reduce the risk of relapse. If the person does relapse while Vivitrol is in their body, the lack of high from the intoxicating substance will not reinforce the future use of that substance in the same way, and they will learn at an unconscious level that they do not want to consume these substances.
A key difference between Vivitrol and Suboxone in terms of the initiation protocol was alluded to above. Although for Suboxone initiation, it is important that someone is not actively intoxicated on opioids and be in some amount of withdrawal, they can usually start it (under the supervision and guidance of their provider) within a few days of last use. However, Vivitrol can require up to 7 to 14 days of full abstinence before therapy can begin, which can be very difficult for many.
Suboxone can also be used during the detox process, while Vivitrol cannot. Because of this, Suboxone has several advantages over Vivitrol when treating opioid use disorder.
How Both Work
Both Suboxone and Vivitrol are beneficial treatments. Someone undergoing treatment for OUD may take both medications at different times in their recovery; however, these medications should not be taken at the same time. Vivitrol contains naltrexone, which kicks opioids off the brain’s opioid receptors, similarly to naloxone. If you take a partial opioid agonist like buprenorphine to manage your body’s withdrawal symptoms, your first shot of Vivitrol will trigger full withdrawal, called precipitated withdrawal.
Suboxone treatment may continue indefinitely, sometimes for years. Many people remain on Suboxone for the rest of their lives because it is so effective at preventing relapse. If you wish to stop taking it, your doctor will work with you to slowly taper off this medication.
Suboxone is only used for OUD, while Vivitrol may work for people overcoming OUD or AUD.
Does Vivitrol block Suboxone?
Yes, Vivitrol can block the agonist effects of Suboxone. You should always consult with your medical provider about the safe time frame and protocol for switching from Suboxone to Vivitrol, if that’s of interest to you.
Is Vivitrol the same as Subutex?
No, Subutex is a buprenorphine-based medicine like Suboxone. Vivitrol is an extended-release naltrexone shot.
How long after Suboxone can you take Vivitrol?
You have to wait until your body completely metabolizes out the last Suboxone dose you took. The recommendation is to wait at least 7 to 14 days, but always work with your medical provider to determine what is best for you.
Is naltrexone the same as naloxone?
No. Naltrexone and naloxone are both opioid antagonists, meaning they kick opioids off the brain’s opioid receptors, so they are similar. However, naltrexone, especially when given as an injection, remains in the body for a long time, while naloxone metabolizes out within a few hours.