Vivitrol Drug Interactions: Mixing Alcohol & Medication with Naltrexone

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AATOD Guidelines for Using Naltrexone (Vivitrol) in OTPs – AATOD. (2022). Retrieved July 1, 2022, from Aatod.org website: https://www.aatod.org/advocacy/policy-statements/aatod-guidelines-for-using-naltrexone-vivitrol-in-otps/

Marks, K. R., Lile, J. A., Stoops, W. W., & Rush, C. R. (2014). Separate and combined impact of acute naltrexone and alprazolam on subjective and physiological effects of oral d-amphetamine in stimulant users. Psychopharmacology, 231(14), 2741–2750. https://doi.org/10.1007/s00213-014-3449-x

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Vivitrol can be taken with most medications without adverse issues. The major exception is opioids. Using opioids while on Vivitrol can be deadly, while drinking alcohol while on Vivitrol is generally just unpleasant.

Category: Addiction Treatment > Vivitrol

Table of Contents

What drugs interact with Vivitrol?

The most dangerous drug interaction with Vivitrol is opioids. Taking opioids while on Vivitrol can lead to severe withdrawal symptoms like body aches or vomiting or overdose symptoms like brain damage, coma or death.

Opioids include: 

Tell your doctor about all medications you are taking, legally or illegally. Opioid medications exist under hundreds of generic and brand names.

Other than opioids, you can take most prescription or over-the-counter medications without adverse reactions.

The combination of alprazolam (Xanax) and naltrexone (Vivitrol) does not appear to cause an adverse reaction. However, alprazolam is not usually an ideal medication for those struggling with addiction issues.

Usually, it’s recommended to wait 72 hours after the last dose of Suboxone before getting the Vivitrol injection. Though, it can be as little as 12 hours depending on the length of time and dosage of Suboxone. Starting Vivitrol too early can trigger opioid withdrawal symptoms.

If patients have a strong recovery foundation, Vivitrol can be a safety net when tapering off of Suboxone. With very few side effects of Vivitrol, it gives some buffer against cravings. Knowing that Vivitrol will prevent the high and that opioid relapse can be deadly certainly raises the stakes and adds an extra deterrent.

(See also — Vivitrol vs. Suboxone article).

Surgery that involves anesthesia can be challenging with Vivitrol. Anesthesia is usually an opioid analgesic, so the pain-relieving effects will be blocked while on Vivitrol. 

It is recommended that elective surgeries accommodate 72 hours of discontinued use of naltrexone or more than 28 days after your last Vivitrol shot. Non-opioid options like non-steroidal anti-inflammatory medications, regional nerve blocks or even dissociative analgesics such as ketamine can be used as an alternative. You can have emergency or even elective surgery while on Vivitrol, but you need to discuss your Vivitrol use, so your doctor understands your best options.

Medical Tag: I am on extended-release naltrexone

No, Vivitrol doesn’t show up on a standard drug test panel. There are specialized drug tests that can detect Vivitrol, though these aren’t commonly used since Vivitrol is not a narcotic.

Can you drink on Vivitrol?

Drinking while on Vivitrol is unpleasant. There is usually no euphoria (ie. “buzz”). But, impairment (like slowed thinking and poor coordination) and hangover symptoms (like nausea and headaches) still occur.

If patients drink on Vivitrol, the positive association with alcohol is weakened. Knowing that they will not get the release of endorphins, patients become less likely to drink and urges for drinking decrease.

Alcohol Withdrawal on Vivitrol

Patients sometimes report withdrawal symptoms are worse when on Vivitrol, but it’s more likely that they drank more to try to get to a “buzz” that doesn’t happen.

Patients should expect withdrawal symptoms to be generally the same as when drinking the same amount not on Vivitrol — including anxiety, shaky hands, headache, nausea, voming, insomnia and sweating.

Vivitrol doesn’t block alcohol, but blocks the pleasant feelings of intoxication that alcohol can give. Alcohol still impacts the body with Vivitrol and still causes impairment, cell damage and withdrawals.

Some patients report that they can get a buzz if they drink much more than usual, which is very dangerous. Drinking extra to try to get a buzz on Vivitrol can lead to alcohol poisoning, which causes coma and death.

Here’s how patients describe drinking on Vivitrol:

“All nausea and no good euphoria.”

“You can still get into a bad stupor. It’s just not enjoyable at all, and worse the next day.”

Get the Vivitrol Shot

Vivitrol is given as an injection monthly by a doctor, but most general physicians won’t keep the medication on hand.  Finding an outpatient addiction clinic is usually your best option. If you’re in Illinois of Texas, Symetria offers same-day Vivitrol appointments.

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Symetria has addiction treatment clinics across Illinois and Texas. You can likely get scheduled TODAY — medications or therapy.