Naltrexone (Vivitrol)

Opioid antagonist

Dosing

50 mg/d. Use with bupropion for weight loss. Gambling-addiction: 150-200mg/d.

Management

Patient must be off opioids for 7-10 days before starting (although not dangerous, can cause severe withdrawal symptoms). Warn of nausea, rare hepatotoxicity (check LFTs). It can be taken with alcohol. May have health benefits as an antioxidant. Compared to daily oral dosing with naltrexone 50 mg over 28 days, total naltrexone exposure is 3 to 4-fold higher following administration of a single dose of VIVITROL 380 mg INJ form is expensive but may be more effective due to adherence issues. Partial-opiate antagonist which reduces the rewarding aspect of many addictive behaviors, it has some positive results for gambling, opioid abuse and alcoholism (not effective for cocaine). Once thought to help dissociation and self-cutting but controlled trials were negative

EMR Text