Get Help & Answers Now

How can we help?

I'm ready to sign up! I have a few questions I want to refer someone Quiz: is Suboxone for me?

Vivitrol Misuse: Risks, Symptoms, and Warning Signs

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 11, 2023 • 9 cited sources

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

Naltrexone (Vivitrol) is an FDA-approved injectable medication for the treatment of alcohol use disorder and opioid use disorder. It is an opioid blocker that must be administered by a health care provider.[2] One of the advantages to Vivitrol is that, unlike Methadone and Suboxone (the other FDA approved medications for OUD), it has no abuse/misuse potential, which may make it an appealing option for anyone concerned about being chemically or physically dependent on substances.

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 opioid use disorder (OUD).

The medication is available as an extended-release intramuscular injectable suspension that is administered by a licensed health care 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 the following:

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

Vivitrol must be administered by a health care professional. You should immediately report any of the following signs or symptoms at any of your injection sites:[2]

  • Open wounds or a dark scab
  • The area feeling hard
  • Feeling lumps in the area
  • Blisters
  • Intense pain
  • Large area of swelling

Naltrexone (Vivitrol) for Alcohol & Opioid Use Disorder

Before starting Vivitrol, you must be opioid-free usually for at least 24 hours. This is because Vivitrol can cause rapid withdrawal from opioids and make individuals feel sick – a phenomenon called “precipitated withdrawal”. [2] While precipitated withdrawal from opioids is extremely unpleasant, it is not life threatening. 

Adverse reactions to Naltrexone are extremely rare, however possible. 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

Are There Reasons A Person Should NOT Use Vivitrol?

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 
  • Using any opioid-containing medications or street (illegal) drugs

If you have any of these conditions, talk to your doctor before you take Vivitrol:

  • Pregnancy or attempting to get pregnant
  • Blood disorder or bleeding problems
  • Liver or kidney problems
  • Use of any street (illegal) drugs
  • Any other medical conditions

Alternatives to Vivitrol for Alcohol & Opioid Use Disorder 

If Vivitrol isn’t right for you, there are other medications available for both alcohol use disorder (AUD) and Opioid use disorder (OUD). These are a few medications used as well: 


Disulfiram, sold under the brand name Antabuse, was the first medication approved by the U.S. Food and Drug Administration for alcohol dependence treatment.[6]


Acamprosate is a second FDA approved medication for alcohol use disorder. It is usually taken 3 times a day and works  by reducing cravings for alcohol. 


Naltrexone also comes in an oral formulation (pill) that is taken once per day. If you’ve struggled with the injection part of Vivitrol therapy, a pill form of naltrexone could be a better fit for you.[8] Naltrexone pill form is FDA approved to treat both AUD and OUD. 


Methadone is one of the oldest medications used in OUD. It is an opioid itself with a long duration of action in the body that provides the user with enough opioid to prevent withdrawal and allow that individual to function. Most people take methadone long term (months to years) to prevent opioid relapse. [7]

Methadone can only be dispensed on a daily basis at a Methadone clinic, which can make treatment burdensome. However, for some people with severe use disorders who desire the accountability that comes with attending a daily program, Methadone can be an excellent choice. 


Suboxone is a prescription medication used to treat opioid use disorder. It comes in a dissolvable film, this medication is taken once, twice or even three times per day to treat OUD cravings and prevent withdrawal. It can be prescribed by a licensed provider in the outpatient/office setting. [9]

If you are interested in treatment for AUD or OUD and think either Vivitrol or any of the above medications might be right for you, reach out to your doctor or to use here at Bicycle health for more information.

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 ... Read More

  1. Substance Abuse. Office of Disease Prevention and Health Promotion. Accessed December 9, 2021.
  2. Vivitrol (Naltrexone) Prescribing Information. Alkermes, Inc. Accessed December 9, 2021.
  3. Long-Acting Injectable Naltrexone for the Management of Patients With Opioid Dependence. Substance Abuse: Research and Treatment. February 2011. Accessed December 9, 2021.
  4. Review of Case Narratives From Fatal Overdoses Associated With Injectable Naltrexone for Opioid Dependence. Drug Safety. October 2018. Accessed December 9, 2021.
  5. Preventing an Opioid Overdose. Centers for Disease Control and Prevention.
  6. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Substance Abuse and Mental Health Services Administration. 2009. Accessed August 2022. 
  7. Methadone. Substance Abuse and Mental Health Services Administration. June 2022. Accessed August 2022. 
  8. What Is Naltrexone? Psychiatric Research Institute. Accessed August 2022. 
  9. Safety Information. Suboxone. Accessed August 2022.

Download Our Free Program Guide

Learn about our program, its effectiveness and what to expect

Safe, effective Suboxone treatment from home. Learn More

Imagine what’s possible on the other side of opioid use disorder.

Our science-backed approach boasts 95% of patients reporting no withdrawal symptoms at 7 days. We can help you achieve easier days and a happier future.