Naltrexone (Vivitrol)
Opioid antagonist
- Alcohol1
- Opioid2
- Methampetamine (with bupropion)2
- Antipsychotic weight gain3
- Obesity (with bupropion)1
- Gambling addiction2
Features
Dosing
50 mg qd with food (can start at 1/2 tab)
Gambling-addiction: target 150-200 mg qd
Obesity and methamphetamine use: combine 50 mg with bupropion XL 150-300 mg (or can use alone for antipsychotic-associated weight gain.
INTERACTIONS: Patient must be off opioids for 7-10 days before starting (although not dangerous, can cause severe withdrawal symptoms).
Management
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. May have health benefits as an antioxidant.
It can be taken with alcohol. 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.
TOLERABILITY: Nausea.
RISKS: Rare hepatotoxicity. Blocks opioid pain meds from working.
EMR Text
Alcohol
Naltrexone use based on FDA approval in alcohol use disorder.
Naltrexone side effects, including elevated LFTs, reviewed wtih patient.
Opioid
Naltrexone use based on FDA approval in opioid use disorder.
Naltrexone side effects, including elevated LFTs, reviewed wtih patient.
Methamphetamine
Naltrexone use based on randomized controlled trials in methamphetamine use disorder.
Naltrexone side effects, including elevated LFTs, reviewed wtih patient.
Gambling, Impulse control
Naltrexone use based on randomized trials in impulse control disorders including compulsive gambling (Kovanen L et al, Eur Addict Res. 2016;22(2):70-79).
Naltrexone side effects, including elevated LFTs, reviewed wtih patient.
Antipsychotic weight gain
Naltrexone use based on small randomized trials where it reduced antipsychotic-associated weight gain (Taveira TH et al, J Psychopharmacol 2014;28(4):395-400).
Naltrexone side effects, including elevated LFTs, reviewed wtih patient.