Naltrexone for Opioid Addiction

What Is Naltrexone for Opioid Addiction?

Naltrexone is an opioid receptor antagonist widely used in opioid addiction treatment today. But this medication is not new. It was synthesized in the 1960s and approved by the Food and Drug Administration in 1984 to block the negative effects of morphine and other opioids on the brain. Through the use of this medication, someone taking opioids does not feel high. They also experience reduced cravings for their drug. These benefits make the medication very useful as part of addiction treatment programs and in combination with counseling to support recovery from opioid addiction.

In 2010, the FDA approved an injectable extended-release version called Vivitrol (XR-NTX). This second generation of medication helps clients who have gone through medically supervised withdrawal stay off of their opioid drugs with greater convenience.

Before using any form of opioid antagonist, it is important to stop using drugs for a minimum of seven to 10 days. Otherwise, taking the medication after opioid physical dependence can trigger immediate withdrawal symptoms. It is also important to visit a doctor for individualized planning before starting a course of treatment. How the medication works vary according to the type of opioid addiction, specific dosing, and other factors unique to each client.

Prescribed under brand names like ReVia, Depade, and Vivitrol, opioid antagonists start working within 30 minutes of the first dose, but cravings for opioids can continue for several weeks after treatment begins. Although it is not a quick fix for opioid addiction, the medication certainly can help pave the road to recovery when well-managed.

How It Works for Addiction Treatment

ReVia, Depade, and Vivitrol are unique among medications in how they work for opioid addiction recovery. Some medications used in addiction treatment reduce cravings for drugs or alcohol, such as methadone and buprenorphine. Both of these are opioid agonists used to block painful withdrawal and reduce cravings.

As an opioid antagonist, this medication attaches to the opioid receptors of the brain. It blocks the high-inducing drugs from binding to these receptors and activating them. In short, the antagonist blocks the high typically caused by narcotic pain medications like:

• Codeine
• Fentanyl
• Hydrocodone
• Methadone
• Morphine
• Oxycodone
• Heroin

Blocking the high, also takes away the desire to use drugs. Without experiencing sedation or euphoria from prescription painkillers or other opioids, clients on medication-assisted treatment (MAT) have no reason to take them. Another benefit of this treatment is that there are no cravings or withdrawals from the medication when treatment ends.

Do Opioid Antagonists Really Work?

Opioids are so highly addictive because of the rush of soothing feelings these drugs produce. Opioid antagonists block these feelings from occurring. This takes away the incentive to misuse opioids for a high. Over time, cravings for the drugs go away. With the help of counseling and other types of addiction treatment, formerly addicted clients are able to develop healthy recovery and maintain a more productive lifestyle.

According to a study published in the National Library of Medicine of the National Institutes of Health in August 2017, using an opioid antagonist can give individuals an advantage in recovery from opioid addiction. This study’s results showed that people using the medication experienced recovery for over twice as long as those not using it before relapse occurred. There were also 21% fewer people who relapsed while on this treatment than those attempting recovery without it. At 24 weeks of the opioid antagonist medication treatment, 18% fewer study participants showed signs of opioid abuse in their urine samples than those not on the MAT.

For some individuals, drug cravings may continue despite taking ReVia, Depade or Vivitrol. This is why it is best to first go through opioid detox and withdrawal before starting the opioid antagonist treatment. It is also important to maintain motivation toward recovery and seek drug counseling and other types of addiction treatment.

Medication-assisted treatment using ReVia, Depade or Vivitrol should be supervised by a medical doctor as part of ongoing care. It is important to tell your doctor if you continue craving opioids or experience other uncomfortable symptoms while taking the medication.

What Other Types of Treatment Do You Need With MAT?

MAT using Revia, Depade, or Vivitrol is not a quick fix for opioid addiction. The medication works best when used as part of a comprehensive addiction treatment program. This program should consist of addiction counseling and other treatment methods. Common types of addiction recovery treatment used with the medication include:

• 12-step programs
• Individual counseling
• Group therapy
• Behavioral therapies
• Medication management
• Inpatient programs
• Outpatient programs

An opioid antagonist helps individuals avoid relapse on opioids by taking away the sought-after benefits of using the drugs. But it is still very important to seek treatment for the root cause of the addiction and why drug abuse started in the first place.

How Do You Use ReVia, Vivitrol or Depade?

Your specific opioid antagonist is prescribed by a medical doctor. It is available as a daily tablet under the brand names Depade or ReVia or as a monthly injectable medication, Vivitrol.

You can also have the medication surgically implanted in your body to deliver doses automatically for up to six months. These implants look like small pellets or lozenges. They are inserted under the fat of the lower abdomen. It is a relatively painless procedure that only takes about five minutes. Local anesthesia is used for implantation.

Precise dosing for medication-assisted treatment varies according to individual needs. It is very important to follow your doctor’s instructions when taking this medication to receive maximum benefit. You can take your oral medicine at home or in a treatment setting according to a specific schedule. You should never adjust your dose or frequency without your doctor advising you to do so.

If you choose to receive Vivitrol injections for your MAT, the medication is injected monthly by a doctor or nurse into a buttocks muscle. This administration must take place in a clinical setting. It is common to experience bruising, discomfort, swelling or redness at the injection site shortly after the procedure. However, many people find the injection much more reliable than taking a daily pill.

Other Uses for Opioid Antagonists

Besides helping many people overcome addiction to opioids, opioid antagonists can also aid in recovery from alcohol dependence. The FDA also approved the medication for this purpose in 1984. Just like with opioids, the medication can stop the effects of alcohol and reduce the desire to drink.

Unlike another drug often used in alcohol addiction treatment, disulfiram, the opioid antagonist does not make you feel ill when you drink. Instead, it takes away the pleasurable feelings associated with getting drunk and reduces cravings for alcohol.

Side Effects of ReVia, Vivitrol, and Depade

Like any drug, ReVia, Vivitrol, and Depade can cause side effects. These ill effects are most likely to occur early in treatment as the body adjusts to the medication and dosing.

Oral Tablet Side Effects

When taking oral ReVia or Depade, some serious side effects can occur. You should seek your doctor’s care immediately for any of these symptoms.

Serious side effects of oral ReVia and Depade include:

• Skin rash
• Severe abdominal or stomach pain
• Blurred vision
• Swollen, aching, or burning eyes
• Fever
• Chest pain
• Hallucinations
• Itching
• Confusion
• Depression or mood changes
• Shortness of breath
• Ringing ears
• Weight gain
• Facial, feet, or lower leg swelling

For some less serious side effects, it is not necessary to seek immediate medical attention. You can discuss these with your doctor for guidance and support. Less serious side effects of ReVia or Depade oral medication include:

• Mild or moderate stomach cramping
• Headache
• Sleep problems
• Anxiety, nervousness, or irritability
• Joint or muscle pain
• Nausea or vomiting
• Fatigue
• Chills
• Constipation or diarrhea
• Cold symptoms
• Dizziness
• Fast heart rate
• Thirstiness
• Lost appetite
• Sexual dysfunction in men

Injection Side Effects

If you receive Vivitrol injections for opioid addiction treatment, there are some serious and common side effects you may experience. In fact, it is normal to feel nauseated after your first injection. You can also suffer a headache, lost appetite, weakness, tiredness, joint pain, muscle pain, or vomiting with your first dose. Some people also notice cold symptoms or tooth pain. Serious side effects of Vivitrol injections include:

• Shallow or weak breathing
• Coughing or wheezing
• Severe pain, scabbing, blistering, or swelling at the injection site
• Liver problems, liver area pain, dark urine, or jaundice
• Depression or mood changes

If you experience any of the serious side effects of your Vivitrol injection, contact your doctor immediately.

Ask Questions and Openly Communicate With Your Doctor during Treatment

It is always important to openly communicate with your doctor about any medication that you are taking. Talk about your concerns and ask any questions you have to understand your dosing and set reasonable expectations for the outcome.

Avoiding relapse is critical when taking an opioid antagonist. Using this medication makes you more sensitive to lower doses of opioids. This means you can easily overdose if relapse occurs after you stop your medication-assisted treatment.

Interactions With Your Opioid Antagonist

Like any medication, an opioid antagonist can interact with other substances. These interactions can occur with prescribed medications, over-the-counter drugs, vitamins, minerals, illicit drugs, alcohol, and herbal remedies. Some of the substances known to interact with ReVia, Vivitrol, and Depade include:

• Cymbalta (duloxetine)
• Adderall (amphetamine/dextroamphetamine)
• Klonopin (clonazepam)
• Lexapro (escitalopram)
• Xanax (alprazolam)
• Wellbutrin XL (bupropion)
• Abilify (aripiprazole)
• Lyrica (pregabalin)
• Prozac (fluoxetine) and Zoloft (sertraline)
• Benadryl (diphenhydramine) and Zyrtec (cetirizine)
• Lamictal (lamotrigine)
• Topamax (topiramate)
• Seroquel (quetiapine)
• Vyvanse (lisdexamfetamine)

Before starting medication-assisted addiction treatment, talk to your doctor about all of your current medications and supplements. Always contact your doctor immediately if you notice any adverse side effects from using your opioid antagonist. It is also important to talk to your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

ReVia, Vivitrol, and Depade are proven effective in helping many individuals overcome opioid addiction as part of medication-assisted treatment. These are prescribed medications only available with a doctor’s prescription and as part of an individualized recovery plan. You can use this medication in your own home as part of outpatient care or may receive it in an inpatient program. However you take it, treatment using an opioid antagonist is designed to help you achieve long-term recovery from opioid addiction.

Get Help for Opioid Addiction Today

Medication-assisted treatment using an opioid antagonist is an effective tool available in the treatment of painkiller addiction. Along with behavioral therapies and other programs, this medication can help you or your loved one achieve lasting recovery.

Do you want to find out whether ReVia, Vivitrol, or Depade will work for you? Start exploring your treatment options, including those offering medication-assisted treatment. Learning about inpatient rehab, outpatient programs, 12-step programs, MAT, individual therapy, group therapy, and other methods can help you find the best fit for lasting recovery. Contact a treatment provider today.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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