Where should a deep intramuscular (IM) injection of Vivitrol (naltrexone) be administered?

Vivitrol Deep IM Injection Sites

Vivitrol (extended-release naltrexone) should be administered as a deep intramuscular injection into the gluteal muscle (upper outer buttock region), alternating between the two buttocks with each monthly injection. 1

Recommended Injection Site

• The gluteal muscle (specifically the ventrogluteal area or upper outer buttock region) is the primary recommended site for Vivitrol administration 1
• The posterior lateral aspect of the upper buttocks provides adequate subcutaneous tissue depth and muscle mass for the 380-mg monthly depot injection 2, 1
• Alternate between the right and left gluteal muscles with each subsequent monthly injection to prevent tissue damage and ensure proper absorption 2

Alternative Sites (If Gluteal Not Feasible)

• The deltoid muscle (middle third posterior aspect of the upper arm) can be used as an alternative site, though this is less commonly recommended for Vivitrol due to the large injection volume 1, 3
• The anterolateral thigh (upper third anterior lateral aspect) is another acceptable alternative for deep IM injections 1, 3

Proper Injection Technique

• Insert the needle at a 90-degree angle to the skin surface to ensure proper deep intramuscular delivery 1, 3
• Use appropriate needle length to reach deep muscle tissue - the gluteal site typically requires a longer needle than other sites 4
• Avoid areas with lipohypertrophy, scars, or damaged tissue, as absorption will be unpredictable 1

Critical Safety Considerations

• Patients must be completely opioid-free for at least 7-10 days before receiving Vivitrol to avoid precipitating severe withdrawal 5, 6
• The injection must be administered by a healthcare professional trained in proper IM injection technique 6
• Monitor injection sites for adverse reactions, as injection-site pain is a common side effect (incidence ≥5%) 6

Common Pitfalls to Avoid

• Do not inject into the deltoid as the primary site for Vivitrol - the gluteal muscle is preferred due to better tolerance of the large volume depot formulation 1
• Avoid superficial injection, which can lead to poor absorption and reduced efficacy 4
• Do not use the dorsogluteal site near the sciatic nerve; instead use the ventrogluteal area which is safer 3