Medical Editor: John P. Cunha, DO, FACOEP
What Is Vivitrol?
What Are Side Effects of Vivitrol?
Common side effects of Vivitrol include:
- loss of appetite,
- increased thirst,
- muscle or joint aches,
- sleep problems (insomnia),
- decreased sex drive,
- impotence, or
- difficulty having an orgasm.
Dosage for Vivitrol
The recommended dosage of Vivitrol is 380 mg taken once a month. Vivitrol must be administered under a doctor's supervision.
What Drugs, Substances, or Supplements Interact with Vivitrol?
Vivitrol may interact with narcotic pain medications including buprenorphine, butorphanol, codeine, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, nalbuphine, naloxone, oxycodone, oxymorphone, or propoxyphene. Tell your doctor all medications and supplements you take. Do not use narcotic drugs or alcohol while taking Vivitrol. Exercise caution if you drive or do anything that requires you to be alert while taking Vivitrol. Wear a medical alert tag or carry an ID card stating you use Vivitrol.
Vivitrol During Pregnancy and Breastfeeding
If you are pregnant only take Vivitrol if the potential benefits outweigh the potential risk to the fetus. Do not take Vivitrol if you are breastfeeding. Use of Vivitrol does not eliminate nor diminish alcohol withdrawal symptoms.
Our Vivitrol (naltrexone) for Extended-Release Injectable Suspension Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
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Get emergency medical help if you have signs of an allergic reaction: hives; chest pain, wheezing, difficult breathing; feeling light-headed; swelling of your face, lips, tongue, or throat.
Using opioid medicine while you are receiving naltrexone injections could stimulate opioid withdrawal symptoms. Common withdrawal symptoms are yawning, sweating, fever, stomach pain, vomiting, diarrhea, watery eyes, runny nose, goose bumps, body aches, shaking, muscle twitching, trouble sleeping, and feeling restless or anxious.
Call your doctor at once if you have:
- weak or shallow breathing;
- new or worsening cough, wheezing, trouble breathing;
- severe pain, swelling, blistering, skin changes, a dark scab, or a hard lump where the medicine was injected;
- liver problems--stomach pain (upper right side), dark urine, tiredness, jaundice (yellowing of the skin or eyes); or
- symptoms of depression--unusual mood or behavior changes, loss of interest in things you once enjoyed, crying, new sleep problems, thoughts about hurting yourself.
You may feel nauseated the first time you receive a naltrexone injection. You may also have a headache, tiredness, joint and muscle pain, loss of appetite, and vomiting.
Common side effects may include:
- nausea, vomiting, loss of appetite;
- joint pain, muscle cramps;
- dizziness, drowsiness;
- sleep problems (insomnia);
- tooth pain; or
- cold symptoms such as stuffy nose, sneezing, sore throat.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Vivitrol (Naltrexone XR Inj)
The following clinically significant adverse reactions are described elsewhere in the labeling:
- Accidental Opioid Overdose [see WARNINGS AND PRECAUTIONS]
- Injection Site Reactions [see WARNINGS AND PRECAUTIONS]
- Precipitated Opioid Withdrawal [see WARNINGS AND PRECAUTIONS]
- Hepatotoxicity [see WARNINGS AND PRECAUTIONS]
- Depression and Suicidality [see WARNINGS AND PRECAUTIONS]
- Eosinophilic Pneumonia [see WARNINGS AND PRECAUTIONS]
- Hypersensitivity Reactions [see WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
In all controlled and uncontrolled trials during the premarketing development of VIVITROL, more than 1100 patients with alcohol and/or opioid dependence have been treated with VIVITROL. Approximately 700 patients have been treated for 6 months or more, and more than 400 for 1 year or longer.
Adverse Events Leading To Discontinuation Of Treatment
In controlled trials of 6 months or less in alcohol-dependent patients, 9% of alcohol-dependent patients treated with VIVITROL discontinued treatment due to an adverse event, as compared to 7% of the alcohol-dependent patients treated with placebo. Adverse events in the VIVITROL 380 mg group that led to more dropouts than in the placebo-treated group were injection site reactions (3%), nausea (2%), pregnancy (1%), headache (1%), and suicide-related events (0.3%). In the placebo group, 1% of patients withdrew due to injection site reactions, and 0% of patients withdrew due to the other adverse events.
In a controlled trial of 6 months, 2% of opioid-dependent patients treated with VIVITROL discontinued treatment due to an adverse event, as compared to 2% of the opioid-dependent patients treated with placebo.
Common Adverse Reactions
Table 1 lists all treatment-emergent clinical adverse reactions, regardless of causality, occurring in ≥5% of patients with alcohol dependence, for which the incidence was greater in the combined VIVITROL group than in the placebo group. A majority of patients treated with VIVITROL in clinical studies had adverse reactions with a maximum intensity of “mild” or “moderate”.
Table 1: Treatment-emergent Adverse Reactions (Reactions in ≥5% of patients with alcohol dependence treated with VIVITROL and occurring more frequently in the combined VIVITROL group than in the placebo group)
|Body System||Adverse Reaction / Preferred Term||Placebo||Naltrexone for extended-release injectable suspension|
|N=214||400 mg N=25||380 mg N=205||190 mg N=210||All N=440|
|Infections & Infestations||Pharyngitisc)||23||11||0||0||22||11||35||17||57||13|
|Psychiatric Disorders||Insomnia, sleep disorder||25||12||2||8||29||14||27||13||58||13|
|General Disorders & Administration Site Conditions||Any ISR||106||50||22||88||142||69||121||58||285||65|
|Injection site tenderness||83||39||18||72||92||45||89||42||199||45|
|Injection site induration||18||8||7||28||71||35||52||25||130||30|
|Injection site pain||16||7||0||0||34||17||22||10||56||13|
|Other ISR (primarily nodules, swelling)||8||4||8||32||30||15||16||8||54||12|
|Injection site pruritus||0||0||0||0||21||10||13||6||34||8|
|Injection site ecchymosis||11||5||0||0||14||7||9||4||23||5|
|Musculoskeletal & Connective Tissue Disorders||Arthralgia, arthritis, joint stiffness||11||5||1||4||24||12||12||6||37||9|
|Back pain, back stiffness||10||5||1||4||12||6||14||7||27||6|
|Skin & Subcutaneous Tissue Disorders||Rashg)||8||4||3||12||12||6||10||5||25||6|
|Nervous System Disorders||Headacheh)||39||18||9||36||51||25||34||16||94||21|
|Metabolism & Nutrition Disorders||Anorexia, appetite decreased NOS, appetite disorder NOS||6||3||5||20||30||14||13||6||48||11|
|a) Includes the preferred terms: diarrhea NOS; frequent bowel movements; gastrointestinal upset; loose stools
b) Includes the preferred terms: abdominal pain NOS; abdominal pain upper; stomach discomfort; abdominal pain lower
c) Includes the preferred terms: nasopharyngitis; pharyngitis streptococcal; pharyngitis NOS
d) Includes the preferred terms: anxiety NEC; anxiety aggravated; agitation; obsessive compulsive disorder; panic attack;
nervousness; posttraumatic stress
e) Includes the preferred terms: malaise; fatigue (these two comprise the majority of cases); lethargy; sluggishness
f) Includes the preferred terms: muscle cramps; spasms; tightness; twitching; stiffness; rigidity
g) Includes the preferred terms: rash NOS; rash papular; heat rash
h) Includes the preferred terms: headache NOS; sinus headache; migraine; frequent headaches
In the open-label, long-term safety study conducted in the US, the commonly reported adverse reactions among the opioid-dependent patients in the study were similar to those commonly observed events in the alcohol-dependent populations in VIVITROL clinical trials as displayed in Table 1, above. For example, injection site reactions of all types, nausea and diarrhea occurred in more than 5% of patients on VIVITROL in the open-label study. In contrast, 48% percent, of the opioid-dependent patients had at least one adverse event in the “Infections and Infestations” Body System. Adverse Reactions/Preferred Terms of nasopharyngitis, upper respiratory tract infection, urinary tract infection, and sinusitis were most commonly reported.
In the placebo-controlled study in opioid-dependent patients conducted in Russia, the overall frequency of adverse events was lower than in the U.S. population described above. Table 2 lists treatment-emergent clinical adverse events, regardless of causality, occurring in ≥2% of patients with opioid dependence, for which the incidence was greater in the VIVITROL group than in the placebo group. All adverse events were assessed as having a maximum intensity of “mild” or “moderate.”
Table 2: Treatment-emergent Clinical Adverse Events (Events in ≥2% of patients with opioid dependence treated with VIVITROL and occurring more frequently in the VIVITROL group than in the placebo group)
|Body System||Adverse Event / Preferred Term||Placebo
|VIVITROL 380 mg
|Investigations||Alanine aminotransferase increased||7||6||16||3|
|Aspartate aminotransferase increased||3||2||13||10|
|Infections and Infestations||Nasopharyngitis||3||2||9||7|
|General Disorders and Administration Site Conditions||Injection site pain||1||1||6||5|
|Nervous System Disorders||Headache||3||2||4||3|
In clinical trials, subjects on VIVITROL had increases in eosinophil counts relative to subjects on placebo. With continued use of VIVITROL, eosinophil counts returned to normal over a period of several months.
VIVITROL 380 mg was associated with a decrease in platelet count. In clinical trials, alcohol-dependent patients treated with VIVITROL experienced a mean maximal decrease in platelet count of 17.8 × 103/μL, compared to 2.6 × 103/μL in placebo patients.
After 24 weeks of treatment, opioid-dependent patients treated with VIVITROL experienced a mean maximal decrease in platelet count of 62.8 × 103/μL, compared to 39.9 × 103/μL in placebo patients. In randomized controlled trials, VIVITROL was not associated with an increase in bleeding-related adverse events.
Hepatic Enzyme Elevations
In short-term, controlled trials, in alcohol-dependent patients, the incidence of AST elevations associated with VIVITROL treatment was similar to that observed with oral naltrexone treatment (1.5% each) and slightly higher than observed with placebo treatment (0.9%).
In the 6-month controlled trial conducted in opioid-dependent subjects, 89% had a baseline diagnosis of hepatitis C infection, and 41% had a baseline diagnosis of HIV infection. There were frequently observed elevated liver enzyme levels (ALT, AST, and GGT); these were more commonly reported as adverse events in the VIVITROL 380 mg group than in the placebo group. Patients could not enroll in this trial if they had a baseline ALT or AST value that was more than three times the upper limit of normal. More patients treated with VIVITROL in this study experienced treatment-emergent elevations in transaminases to more than three times the upper limit of normal than patients treated with placebo. Shifts to more than three times the upper limit of normal occurred in 20% of patients treated with VIVITROL as compared with 13% of placebo patients. Shifts in values of AST to more than three times the upper limit were also more common in the VIVITROL (14%) arm compared with the placebo (11%) arm. Opioid-dependent patients treated with VIVITROL experienced a mean maximal increase from baseline ALT levels of 61 IU/L compared with 48 IU/L in placebo patients. Similarly for AST, opioid-dependent patients treated with VIVITROL experienced a mean maximal increase from baseline AST levels of 40 IU/L compared with 31 IU/L in placebo patients.
In short-term controlled trials in alcohol-dependent patients, more patients treated with VIVITROL 380 mg (11%) and oral naltrexone (17%) shifted from normal creatinine phosphokinase (CPK) levels before treatment to abnormal CPK levels at the end of the trials, compared to placebo patients (8%). In open-label trials, 16% of patients dosed for more than 6 months had increases in CPK. For both the oral naltrexone and VIVITROL 380 mg groups, CPK abnormalities were most frequently in the range of 1–2 × ULN. However, there were reports of CPK abnormalities as high as 4x ULN for the oral naltrexone group, and 35 × ULN for the VIVITROL 380 mg group. Overall, there were no differences between the placebo and naltrexone (oral or injectable) groups with respect to the proportions of patients with a CPK value at least three times the upper limit of normal. No factors other than naltrexone exposure were associated with the CPK elevations.
More opioid-dependent patients treated with VIVITROL 380 mg (39%) shifted from normal creatinine phosphokinase (CPK) levels before treatment to abnormal CPK levels during the study as compared to patients treated with placebo (32%). There were reports of CPK abnormalities as high as 41.8 × ULN for the placebo group, and 22.1 × ULN for the VIVITROL 380 mg group.
Other Events Observed During The VIVITROL Clinical Studies
The following is a list of treatment-emergent adverse reactions reported by alcohol- and/or opioid-dependent subjects treated with VIVITROL in all clinical trials. The listing does not include those events already listed in the previous tables or elsewhere in labeling, those events for which a drug cause was remote, those events that were so general as to be uninformative, and those events reported only once that did not have a substantial probability of being acutely life-threatening.
Blood and Lymphatic System Disorders – lymphadenopathy (including cervical adenitis), white blood cell count increased
Cardiac Disorders – angina pectoris, angina unstable, atrial fibrillation, cardiac failure congestive, coronary artery atherosclerosis, myocardial infarction, palpitations
Eye Disorders – conjunctivitis, vision blurred
Gastrointestinal Disorders – abdominal discomfort, colitis, constipation, flatulence, gastroesophageal reflux disease, gastrointestinal hemorrhage, hemorrhoids, pancreatitis acute, paralytic ileus, perirectal abscess
General Disorders and Administration Site Conditions – chest pain, chest tightness, chills, face edema, irritability, lethargy, pyrexia, rigors
Hepatobiliary Disorders – cholecystitis acute, cholelithiasis
Immune System Disorders – seasonal allergy, hypersensitivity reaction (including angioneurotic edema and urticaria)
Infections and Infestations – bronchitis, gastroenteritis, laryngitis, pneumonia, sinusitis, tooth abscess, upper respiratory tract infection, urinary tract infection, advanced HIV disease in HIV- infected patients
Investigations – weight decreased, weight increased
Metabolism and Nutrition Disorders – appetite increased, dehydration, heat exhaustion, hypercholesterolemia
Musculoskeletal and Connective Tissue Disorders – joint stiffness, muscle spasms, myalgia, pain in limb
Nervous System Disorders – cerebral arterial aneurysm, convulsions, disturbance in attention, dysgeusia, mental impairment, migraine, ischemic stroke, paresthesia
Pregnancy, Puerperium, and Perinatal Conditions – abortion missed
Psychiatric Disorders – abnormal dreams, agitation, alcohol withdrawal syndrome, euphoric mood, delirium, libido decreased
Respiratory, Thoracic, and Mediastinal Disorders – chronic obstructive pulmonary disease, dyspnea, pharyngolaryngeal pain, sinus congestion
Skin and Subcutaneous Tissue Disorders – night sweats, pruritus, sweating increased
Vascular Disorders – deep venous thrombosis, hot flushes, pulmonary embolism
Adverse Events Following Patient Self-Administration
Adverse events including injection site reactions and precipitated opioid withdrawal resulting in serious outcomes, including hospitalization, have been reported following patient self-administration of VIVITROL. VIVITROL must be prepared and administered by a healthcare provider.
Hypersensitivity Reactions Including Anaphylaxis
Hypersensitivity reactions including anaphylaxis have been reported during postmarketing surveillance.
Reports From Other Intramuscular Drug Products Containing Polylactide-Co-Glycolide (PLG) Microspheres
Retinal Artery Occlusion
Retinal artery occlusion after injection with another drug product containing polylactide-coglycolide (PLG) microspheres has been reported very rarely during postmarketing surveillance. This event has been reported in the presence of abnormal arteriovenous anastomosis. No cases of retinal artery occlusion have been reported during VIVITROL clinical trials or postmarketing surveillance. VIVITROL should be administered by intramuscular (IM) injection into the gluteal muscle, and care must be taken to avoid inadvertent injection into a blood vessel [see DOSAGE AND ADMINISTRATION].
Patients taking VIVITROL may not benefit from opioid-containing medicines. Naltrexone antagonizes the effects of opioid-containing medicines, such as cough and cold remedies, antidiarrheal preparations and opioid analgesics.
Read the entire FDA prescribing information for Vivitrol (Naltrexone XR Inj)
© Vivitrol Patient Information is supplied by Cerner Multum, Inc. and Vivitrol Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.