Drinking While Using Vivitrol


alcohol-and-vivitrol

Vivitrol is a brand name, extended-release form of the opioid antagonist medication naltrexone. The extended-release form allows it to be administered once every four weeks, in contrast to the daily dosing required with the oral tablet form.1

Naltrexone is what’s known as an opioid antagonist. When used, it competitively binds to opioid receptors throughout the brain. This receptor blockade results in a decrease in receptor activation by either exogenous (e.g., heroin, prescription painkillers) or endogenous opioids (e.g., natural endorphins) and, though the precise mechanism is not fully understood, is subsequently associated with decreased alcohol consumption in people being treated for alcohol use disorder.1

Naltrexone has no associated abuse liability, as it does not elicit any rewarding euphoria other potentially-desirable psychoactive effects. Unlike opioid agonist medications, the drug is not a controlled substance, though it does require a prescription from a physician.

Drinking Alcohol While on Vivitrol

There are no immediate pharmacologic contraindications listed involving the combination of alcohol and naltrexone,1 though some issues may arise as a result of Vivitrol’s side effects. For instance, some side effects may be increased in people who have developed certain serious physical issues as a result of chronic, excessive drinking (see below).

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) released a guide for clinicians  that outlines the pharmacologic options for treating patients with alcohol use disorders. This guide includes some important details to consider regarding the use of alcohol and Vivitrol together:2

  • Naltrexone products do not reduce the intoxicating effects of alcohol, such as physical issues with slowed reflexes and diminished coordination, and the characteristic effects on mental function.
  • Using naltrexone does not result in an individual being able to drink more alcohol than normal; naltrexone does not increase one’s tolerance for alcohol.
  • Naltrexone may help reduce cravings or urges to continue drinking alcohol once one has started drinking.
  • The effects of naltrexone appear to be successful in reducing overall intake of alcohol.
  • Though naltrexone may be useful in reducing cravings and the amount of alcohol that one drinks, it should be used in conjunction with therapy to maximize its therapeutic utility for those in recovery from an alcohol use disorder.

Naltrexone is also indicated in the treatment of opioid use disorders (e.g., heroin abuse, the abuse of prescription narcotic pain medications, etc.), though the NIAAA guide only details its role in helping individuals with alcohol abuse issues decrease their intake of alcohol.

Other details of the guide indicate some of the limits of naltrexone use:2

  • Naltrexone alone has not been demonstrated to result in full abstinence from alcohol use (rather, a reduction in the number of days of heavy drinking have been demonstrated with use).
  • Naltrexone’s mechanisms do not involve the production of negative effects associated with alcohol use that would dissuade the person from continuing to drink alcohol (e.g., the nausea, vomiting, etc. associated with disulfiram or Antabuse use).
  • Naltrexone should not be viewed as a “cure” for alcohol use disorder.
  • Naltrexone will not reduce the symptoms or effects of alcohol withdrawal (i.e., naltrexone is not a detox or withdrawal management medication).
  • Naltrexone alone is not a replacement for behavioral treatments for individuals with alcohol use disorders.
  • Naltrexone will not counteract many of the potential short-term and long-term effects associated with alcohol use disorder (e.g., issues at work, with physical health, with cognition, etc.).

Some of the utility of Vivitrol and other naltrexone products is in reducing cravings for alcohol. As mentioned, though the precise mechanism of action may not be entirely clear, its diligent use can result in a reduction in the amount of alcohol one drinks once one has started drinking. Using naltrexone alone may not result in abstinence from alcohol. Individuals with moderate to severe alcohol use disorders who are having difficulties remaining abstinent from alcohol may find it reduces their cravings for alcohol.2 Such individuals may still need to become involved in a formal alcohol use disorder treatment program in order to maximize their chances of a successful recovery.

There have been several different approaches that have attempted to increase the effectiveness of the drug in reducing cravings for alcohol and alcohol intake in individuals who begin drinking after using the drug. For instance, there is limited evidence from a research study that has indicated that if a person takes the pill form of the drug about an hour before they begin to use alcohol, they tend to drink alcohol in lesser amounts than they normally would.3

However, the standard approach used by most physicians who prescribe naltrexone products in pill form is to instruct the individual to take it early in the morning in an attempt to reduce cravings for alcohol throughout the day. The extended-release form (Vivitrol) may increase the convenience use and the associated utility of naltrexone. However, the research does not support the use of naltrexone alone to treat individuals with alcohol use disorders, nor does the research support the idea that using naltrexone products such as Vivitrol will produce abstinence in individuals with alcohol abuse issues. In addition, most sources, like the FDA, suggest that an individual should be abstinent from alcohol for at least a week to 10 days before they take naltrexone products like Vivitrol in order for it to be most effective in reducing cravings for alcohol and reducing the amount of alcohol one consumes.4

 Vivitrol and other drugs containing naltrexone have relatively few side effects, and the drug is considered to be safe to use in most individuals; however, every medication or drug has a side effect profile.


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Naltrexone use may result in certain side effects:5

  • Nausea, diarrhea, and stomach cramps are the most common side effects.
  • Headache, muscle cramps, or muscle stiffness may occur in some people.
  • Some individuals may have issues with insomnia or hypersomnia (sleeping too much).
  • Some individuals may experience jitteriness, anxiety, or irritability.
  • People who are actively using opiate drugs or women who are pregnant should not use products that contain naltrexone.
  • Naltrexone is contraindicated for use in people with hepatitis or liver failure, and people with either of these conditions (potentially in association with chronic alcohol use) may be at increased risk for serious liver complications if they use Vivitrol.

Conclusions

Vivitrol is the extended-release form of the opiate antagonist naltrexone. It can reduce alcohol intake and alcohol cravings in some individuals, and it is often prescribed for that purpose. Drinking alcohol while taking Vivitrol is not associated with any significant risks other than the normal side effect profile. Some sources suggest that Vivitrol should be taken before one plans to drink alcohol in order to reduce overall alcohol intake.

References

  1. U.S. Department of Health and Human Services—Food & Drug Administration. (2019). Labelling-Medication Guide: Vivitrol.
  2. NIAAA. (2008). Helping Patients Who Drink Too Much: A Clinician’s Guide Prescribing Medications for Alcohol Dependence.
  3. Sinclair JD. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol. 2001;36(1):2-10. doi:10.1093/alcalc/36.1.2
  4. Naltrexone | SAMHSA – Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone. Accessed June 22, 2019.
  5. FDA. Revia (Naltrexone Hydrochloride Tablets USP) 50 Mg Opioid Antagonist.

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About The Contributor

Shirley received her MD from the University of Western Ontario. She trained in family medicine and has experience working in laboratory medicine, medical education, medical writing, and editing. Shirley recently completed a MHSc in Translational... Read More


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