Naltrexone

Naltrexone is the active ingredient in the brand-name drug Vivitrol^®, an injectable medication used to prevent relapse in people with alcohol and opioid dependence. While Vivitrol is a once-monthly injection, naltrexone is also available as a daily pill. Healthcare providers may, at their own discretion, prescribe it off-label to help support weight loss efforts. 

The medication works by blocking the pleasurable effects of opioids and alcohol, which helps reduce cravings and makes relapse less likely. It’s FDA-approved to treat alcohol use disorder and opioid use disorder. 

Common side effects include nausea, vomiting, dizziness, decreased appetite, and injection site reactions, while serious risks include liver damage and symptoms of sudden opioid withdrawal. People with liver disease or who have recently used opioids should be cautious about using this drug.

Vivitrol (naltrexone) is indicated:

• For the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with Vivitrol. Patients should not be actively drinking at the time of initial Vivitrol administration

• For the prevention of relapse to opioid dependence, following opioid detoxification

Vivitrol should be part of a comprehensive management program that includes psychosocial support

Opioid antagonist

The adverse events seen most frequently in association with Vivitrol therapy for alcohol dependence (i.e, those occurring in ≥5% and at least twice as frequently with Vivitrol than placebo) include:

• Nausea

• Vomiting

• Injection site reactions (including induration, itchiness, nodules, and swelling)

• Muscle cramps

• Dizziness or fainting

• Sleepiness or sedation

• Anorexia

• Decreased appetite or other appetite disorders

The adverse events seen most frequently in association with Vivitrol therapy in opioid-dependent patients (i.e., those occurring in ≥2% of patients treated with Vivitrol and at least twice as frequently with Vivitrol than placebo) were:

• Liver enzyme abnormalities

• Injection site pain

• Inflammation of the nose and throat

• Insomnia

• Toothache

The cost of naltrexone varies depending on your insurance plan, which pharmacy you use, the dosage, and the quantity. Without insurance, generic naltrexone may cost about $35 for 20 oral tablets or about $86 for 60 tablets. A once-monthly injection of Vivitrol costs about $1,700 without insurance. Insurance plans may cover all or some of the costs.

You may also be eligible for manufacturer coupons, discount cards, or patient assistance programs if you meet certain criteria. Ask your provider or pharmacist if you qualify.

• Patients receiving opioid analgesics

• Patients with current physiologic opioid dependence

• Patients in acute opioid withdrawal

• Any individual who has failed the naloxone challenge test or has a positive urine screen for opioids

• Patients who have previously exhibited hypersensitivity to naltrexone, polylactide-co-glycolide (PLG), carboxymethylcellulose, or any other components of the diluent

• Naltrexone antagonizes the effects of opioid-containing medicines, such as cough and cold remedies, antidiarrheal preparations, and opioid analgesics

• Vulnerability to opioid overdose

• Injection site reactions

• Precipitation of opioid withdrawal

• Liver toxicity

• Depression and suicidality

• When reversal of Vivitrol blockade is required for pain management: In an emergency situation in patients receiving Vivitrol, suggestions for pain management include regional analgesia or use of non-opioid analgesics

• Eosinophilic pneumonia

• Hypersensitivity reactions including anaphylaxis

*This information is from the label for brand name Vivitrol^®. See the Full Prescribing Information for more complete information. Naltrexone, the active ingredient in Vivitrol, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient naltrexone.