Vivitrol is a once-a-month injection used to treat opioid and alcohol addiction. Its active ingredient is naltrexone, a medication that blocks the effects of opioids and takes the reward out of drinking. Unlike some other treatments, it is not an opioid itself, it causes no physical dependence, and there is nothing to take every day. One shot lasts about a month.
That once-monthly design appeals to a lot of people, but Vivitrol works very differently from a medication like Suboxone, and understanding that difference is the key to knowing whether it is a good fit.
What Vivitrol Is
Vivitrol is the brand name for extended-release naltrexone. The standard dose is a 380 mg intramuscular injection, given in the buttock by a healthcare provider roughly every four weeks. Naltrexone also comes as a daily pill, but Vivitrol packages it into a long-acting shot so there is no daily dosing to remember, and no way to skip a day when motivation dips. It is approved to treat both opioid use disorder and alcohol use disorder.
| Medication | What it is | How often | Key difference |
|---|---|---|---|
| Vivitrol | Extended-release naltrexone injection | Every 4 weeks, given by a provider | Blocks opioids and dampens alcohol cravings; non-addictive; requires an opioid-free start |
| Oral naltrexone | The same medication as a tablet | Daily | Same blocking effect, but it only works on days you take it |
| Suboxone | Buprenorphine with naloxone | Daily film or tablet | Partially activates opioid receptors instead of blocking them; easier start, but creates dependence |
How Vivitrol Works
Naltrexone is an opioid antagonist, which means it blocks opioid receptors rather than activating them. This is the opposite of how buprenorphine in Suboxone works. With those receptors blocked, opioids cannot produce a high, which removes much of the incentive to use. For alcohol, naltrexone dampens the pleasurable, reinforcing effects of drinking and reduces cravings, so drinking becomes less rewarding and easier to cut back or stop.
Because it only blocks and never activates, Vivitrol produces no high, no sedation, and no dependence of its own. There is nothing to misuse and nothing to taper.
Vivitrol for Opioid Use Disorder
There is one important requirement. Because Vivitrol blocks opioid receptors, starting it while opioids are still in your system can trigger sudden, severe withdrawal. For that reason, a person needs to be fully off opioids, usually for about 7 to 10 days, before the first injection. That often means completing medically supervised detox first. It is the main trade-off of Vivitrol: no daily medication, but a harder starting line.
There is also a safety point worth knowing. After stopping Vivitrol, or if the dose wears off, a person’s tolerance to opioids is lower than before. Using the same amount as in the past can be dangerous. This is one more reason Vivitrol works best inside a full medication-assisted treatment plan rather than on its own.
Vivitrol for Alcohol Use Disorder
For alcohol, the starting requirements are easier. A person does not need to be completely abstinent to begin, though many start after an initial period without drinking. By reducing cravings and the reward of alcohol, Vivitrol helps people drink less or stop, especially when paired with counseling. If you are weighing the full range of alcohol medications, our guide to medications for alcohol use disorder compares the options.
Can You Drink on Vivitrol?
Physically, yes. Vivitrol is not like disulfiram, which makes you sick if you drink. It will not cause a reaction. What it does is make drinking less satisfying and cravings quieter, which is exactly the point. It is worth being clear, though, that Vivitrol does not protect you from the dangers of heavy drinking, so it is a tool for cutting back and quitting, not a green light.
Who Vivitrol Works Best For
Certain situations point toward Vivitrol again and again. People coming out of detox or a residential program are natural fits, since the opioid-free requirement is already met and the monthly shot protects the transition home, which is when relapse risk runs highest. It suits people who know a daily medication will not survive contact with their real life, and people whose work restricts opioid-based medications, which comes up in healthcare, transportation, and other safety-sensitive jobs.
It is also the only option on this list that treats opioid and alcohol use disorder at the same time, which matters more often than people expect, since the two frequently overlap. And for anyone who simply wants nothing opioid-based in their recovery, Vivitrol is the answer to that preference rather than an argument against it.
Vivitrol Side Effects
Most people tolerate Vivitrol well. The most common side effects are soreness, swelling, or itching at the injection site, along with nausea, headache, tiredness, decreased appetite, and muscle or joint aches, especially after the first shot or two. These usually ease as your body adjusts.
A few things deserve a call to your provider rather than waiting: an injection site that becomes very painful, hard, blistered, or dark, since serious injection-site reactions occasionally need care; new or worsening depression or thoughts of self-harm; signs of liver trouble such as yellowing skin or eyes or dark urine; or trouble breathing. And the most important safety fact repeats from above: because your tolerance drops on Vivitrol, a return to opioid use carries a real overdose risk. Your provider will walk through all of this before the first injection.
What Vivitrol Costs and Whether Insurance Covers It
The sticker price surprises people: without coverage, a single monthly injection can run well over a thousand dollars. Very few people pay that. Most commercial insurance plans cover Vivitrol for opioid or alcohol use disorder, MassHealth covers it in Massachusetts, and the manufacturer offers a copay savings program that brings many people’s out-of-pocket cost down substantially. The practical move is not to rule it out over price. It is to check what your specific plan covers, which our team can do for you as part of insurance verification.
What to Expect Starting Vivitrol
Treatment begins with an assessment to confirm you are an appropriate candidate and, for opioid use disorder, that you have been off opioids long enough. That first visit is more thorough than a typical prescription: expect liver function labs, a review of every medication you take, and for opioid use disorder, confirmation that your system is clear, sometimes with a small test dose of oral naltrexone first to make sure the injection will not trigger withdrawal. The shot itself takes minutes, and it is repeated about every four weeks. Counseling and support run alongside it, because the medication removes the pull of the substance while therapy addresses everything underneath it.
If a monthly appointment slips, call rather than wait. A late injection means the blockade fades, and for opioid use disorder that gap is exactly when lowered tolerance makes a return to use most dangerous. Rescheduling quickly keeps the protection continuous.
Is Vivitrol Right for You?
Vivitrol is one of several medications we use in our medication-assisted treatment program in South Shore Massachusetts, and the right choice depends on your history and goals. If you want to compare it with a daily option, our guide on Suboxone versus Vivitrol breaks down the differences. To talk through what fits, verify your insurance or call us at 855-732-4842.
Frequently Asked Questions
How long does Vivitrol last?
Each 380 mg injection works for about four weeks, which is why it is given roughly once a month.
Do you have to be sober to start Vivitrol?
For opioid use disorder, yes. You need to be off opioids for about 7 to 10 days first to avoid triggering withdrawal. For alcohol use disorder, full abstinence is not required to begin, though a short break from drinking is common.
Is Vivitrol addictive?
No. Naltrexone only blocks receptors, so it causes no high and no physical dependence, and there is nothing to taper.
What are the most common Vivitrol side effects?
Injection-site soreness, nausea, headache, tiredness, and muscle or joint aches, most noticeable after the first injections. Serious reactions are uncommon but worth knowing; your provider will review them.
How much does Vivitrol cost?
The list price runs well over a thousand dollars per injection, but most commercial plans and MassHealth cover it, and a manufacturer copay program lowers costs further. Verifying your insurance is the fastest way to learn your actual cost.
Can you drink on Vivitrol?
You can, and it will not make you sick. It reduces cravings and the reward of alcohol, which helps people drink less, but it does not protect against the harms of heavy drinking.
This article is for general education and is not medical advice. Questions about Vivitrol or starting treatment should go to a licensed provider who knows your history.