Quick Summary
Vivitrol is the brand name for extended-release naltrexone, an FDA-approved monthly injection used to treat opioid use disorder and alcohol use disorder. Unlike methadone or buprenorphine, it does not activate opioid receptors. Instead it blocks them. This guide walks through how Vivitrol works, who it may fit, what the evidence shows, and how it compares to other medications.
Key Takeaways
- Vivitrol is a monthly injection of naltrexone, an opioid receptor antagonist.
- It treats both opioid use disorder and alcohol use disorder, with FDA approval for both.
- Patients must be fully detoxed from opioids (typically 7 to 10 days) before starting Vivitrol.
- Retention is lower than methadone or buprenorphine, but Vivitrol may fit people who want a non-agonist option.
- It works best with counseling, peer support, and treatment for any co-occurring conditions.
Vivitrol (extended-release naltrexone) is one of three FDA-approved medications for opioid use disorder and one of three for alcohol use disorder. It works differently from methadone or buprenorphine and fits a particular subset of people who want a medication that does not activate opioid receptors at all. The information here comes from the FDA’s Medications for Opioid Use Disorder page and the NIDA MOUD overview.
How Vivitrol Works
Naltrexone is an opioid antagonist. It binds to opioid receptors but does not activate them. The result is that opioids cannot produce a high. This removes the reinforcement loop for some people who use opioids. The Vivitrol formulation is an injectable that delivers naltrexone slowly over about 28 days, eliminating the need for daily dosing.
For alcohol use disorder, naltrexone also reduces cravings and the reward of drinking, making it easier to maintain abstinence or reduce drinking.
Detox Required Before Starting
This is the most important practical consideration. Because Vivitrol blocks opioid receptors completely, starting it while opioids are still in the system causes immediate precipitated withdrawal, which can be severe. Patients must be fully detoxed (typically 7 to 10 days off short-acting opioids, longer for methadone) before the first injection. This requirement is one reason retention is lower than with methadone or buprenorphine, where treatment can start without prior detox.
Evidence and Effectiveness
Research shows mixed results when comparing naltrexone to other opioid use disorder medications. Methadone and buprenorphine consistently outperform naltrexone on retention and overdose prevention in real-world settings. However, for people who successfully start and stay on Vivitrol, outcomes can be strong: once participants were successfully initiated, extended-release naltrexone was about as effective as buprenorphine-naloxone at preventing relapse in the X:BOT trial, with the difference showing up mainly at the initiation stage. Vivitrol has also shown clear effectiveness for alcohol use disorder, with research demonstrating reduced heavy drinking days and craving reduction.
Overdose Risk Considerations
Patients on Vivitrol have lost opioid tolerance from the medication’s blockade. If a patient returns to opioid use after Vivitrol wears off or is missed, overdose risk is elevated because their tolerance is lower than before. This is a particularly important conversation point with patients and families.
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Who May Be a Good Fit
- People who want a non-agonist medication option.
- People who have completed detox and are committed to abstinence.
- People who have completed opioid detox and are committed to an abstinence-based, non-agonist approach.
- People with alcohol use disorder, where naltrexone has strong evidence.
- People who travel frequently or cannot manage daily dosing or clinic visits.
- People in legal-mandated treatment with structure for follow-through.
Common Side Effects
Most common side effects include injection site reactions, nausea, headache, fatigue, and decreased appetite. Serious but rare side effects include hepatotoxicity at high doses (not typically seen at clinical doses) and severe injection site complications.
What the Treatment Plan Looks Like
A typical Vivitrol-based treatment plan combines the monthly injection with regular counseling, peer recovery support, and treatment for any co-occurring mental health conditions. The medication creates a window of stability that allows the broader work of recovery to happen.
Talking With a Professional
If Vivitrol is being considered for you or someone you love, the next step is a conversation with a qualified clinician. They can assess fit, walk through what the detox-to-Vivitrol bridge will look like, and explain what counseling and support will look like alongside it. The admissions team at Discovery Point Retreat can talk through what an assessment involves and what options exist.
References
- Lee JD, Nunes EV, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). Lancet. 2018;391(10118):309-318. Full text.
- Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder. Accessed June 8, 2026. samhsa.gov.
- US Food and Drug Administration. Information about medications for opioid use disorder (MOUD). Accessed June 8, 2026. fda.gov.
- National Institute on Drug Abuse. Medications to treat opioid use disorder. Accessed June 8, 2026. nida.nih.gov.
Resources
- 988 Suicide and Crisis Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential support 24/7.
- SAMHSA National Helpline. Call 1-800-662-HELP (4357) or visit the SAMHSA National Helpline page for free, confidential referrals to local treatment.
- 911. For any medical emergency, including suspected overdose, call 911 immediately.
This article is general education and is not medical advice.
