Vivitrol (Naltrexone) Treatment Regimen for Alcohol Abuse
For alcohol abuse treatment, Vivitrol (injectable naltrexone) is administered as a 380 mg intramuscular injection once every 28 days, combined with psychosocial therapy. 1, 2
Mechanism and Efficacy
Naltrexone works by:
- Blocking opioid receptors in the brain
- Reducing alcohol cravings
- Decreasing the rewarding effects of alcohol
- Helping maintain abstinence and prevent relapse
Vivitrol (injectable naltrexone) offers significant advantages over oral naltrexone:
- Eliminates daily dosing requirements
- Ensures medication compliance
- Provides consistent therapeutic levels throughout the month
- Reduces risk of missed doses 3, 4
Pre-Treatment Assessment
Before initiating Vivitrol:
- Ensure patient is opioid-free for 7-10 days
- Perform liver function tests (baseline)
- Rule out need for pain management with opioids (contraindicated)
- Assess for alcohol withdrawal symptoms (treat if present before starting)
Treatment Protocol
Dosing
- 380 mg intramuscular injection
- Administered once every 28 days (monthly)
- Continue for at least 3-6 months, with possibility of longer treatment based on response 2
Monitoring
- Liver function tests every 3-6 months
- Monitor for injection site reactions
- Assess treatment response and adherence to psychosocial therapy
Comprehensive Treatment Approach
Vivitrol should always be used as part of a comprehensive treatment program that includes:
- Psychosocial counseling
- Support groups (e.g., Alcoholics Anonymous)
- Behavioral therapy
- Regular follow-up appointments 1
Clinical Considerations and Precautions
Contraindications
- Current opioid use or anticipated need for opioid analgesics
- Acute hepatitis or liver failure
- Hypersensitivity to naltrexone
Potential Adverse Effects
- Injection site reactions
- Nausea and headache
- Potential hepatotoxicity at high doses (not typically seen at recommended dosage)
- Cannot be used with opioid pain medications 2, 4
Special Populations
Patients with Liver Disease
- Use with caution in patients with mild to moderate liver disease
- Monitor liver function more frequently
- Consider alternative treatments in severe liver disease 1
Patients with Comorbid Psychiatric Conditions
- Address underlying psychiatric conditions concurrently
- May need integrated treatment approach for dual diagnoses
Treatment Outcomes
Patients treated with Vivitrol can expect:
- Reduced heavy drinking days
- Increased abstinence rates
- Decreased alcohol cravings
- Better quality of life when combined with psychosocial support 2, 4
Vivitrol is not uniformly effective for all patients, but provides modest improvement in treatment outcomes when used as directed and combined with comprehensive psychosocial treatment.