Vivitrol Side Effects: What to Expect After the Vivitrol Injection

Clinical Reviewer

Vivitrol for alcohol or drug addiction is well tolerated with few side effects that are mild and generally go away with time.

Physical Health Side Effects of Vivitrol

What does Naltrexone do to the body?

Naltrexone blocks opioid receptors in the brain to prevent the receptor from sending signals craving alcohol or drugs. 

While alcohol doesn’t directly attach to opioid receptors, it is believed a genetic mutation in the opioid receptors contributes to alcohol issues. Symetria often tests patients for this OPRM-1 gene, since those without the gene mutation tend to respond better to naltrexone treatment. 

What are the side effects of Vivitrol?

Generally, any side effects from Vivitrol are mild and go away within the first few days or weeks.

The most common side effects of Vivitrol are:

NOTE: The side effects are nothing like the severity of alcohol or opioid withdrawal.

Side Effects of Vivitrol vs. Precipitated Withdrawals

The side effects of Vivitrol can be confused with precipitated withdrawals. Vivitrol should only be taken after the body is cleared of alcohol or drugs, especially opioids. Usually, the time frame is 7-14 days after the last use. If Vivitrol is administered too soon, severe symptoms can occur. 

Precipitated withdrawal symptoms include more severe versions of the side effects listed above, as well as joint and muscle pain, fever, sweating and confusion.

Other Physical Side Effects of Vivitrol

The initial dose of the medication may cause some people to feel lightheaded or drowsy or to feel nervous or have trouble sleeping. If these side effects don’t wear off in a few days, talk to your doctor.

“The first three days, I felt like something had a physical grip on my brain. Feeling a little cloudy, sweaty and emotionless. But, feeling better on day four. Able to go to work and everything. ”​

Nausea is one of the most common side effects of Vivitrol, usually only after the first injection and only lasting for a few hours or days. 

“I had to take two days off work, because I was feeling bad. But, the majority of side effects weaned off after day four for me and never came back.”

“Just the night I got the shot, I felt a little nauseous and achy. It faded from there and I didn’t feel any kind of sick after getting my second shot.”

Does Vivitrol cause stomach problems?

Vivitrol doesn’t usually cause stomach problems, but nausea, vomiting, diarrhea and stomach pain are possible. Usually, these stomach issues are mild and resolve quickly, potentially the same day.

No, research shows those taking naltrexone seem to eat less and may have reduced enjoyment of eating. Though, the official side effects from the manufacturer report neither weight gain nor weight loss.

Is Naltrexone used for food addiction?
Yes, naltrexone can be used for binge eating disorders. Research indicates naltrexone works in food addiction by blocking reward pathways, not necessarily blocking cravings like sugar. There is ongoing research on naltrexone as an option for overweight management.

Though technically a reported side effect, liver injury is rare with Vivitrol. In fact, research suggests that the rate of liver injury is the same as with a placebo. Naltrexone taken at high doses would be more likely to lead to liver injury, but dosage with Vivitrol is controlled.

Many people struggling with alcohol use have liver issues even if they don’t know it. Vivitrol can still be an appropriate medication. Your doctor will weigh the risks of Vivitrol versus the risk of alternative medications or continued drinking, which would be worse for liver damage.

If patients have a pre-existing history of impaired liver function or show signs of liver disease, then blood work to check liver functioning may be ordered prior to initiating Vivitrol.

Can Vivitrol cause hepatitis?

No, Vivitrol does not cause hepatitis and more recent studies even suggest Vivitrol can safely be used in patients with mild to moderate hepatitis infections. Hepatotoxicity with naltrexone can occur at doses 6x greater than the FDA-recommended dosages, but Vivitrol controls dosing by design.

Vivitrol injections aren’t particularly painful. As with any shot, there may be soreness or tenderness in the area that lasts for a day or so.

Where is the Vivitrol injection given?
Vivitrol shots are usually given on the side of the buttocks.

Mental Health Side Effects of Vivitrol

Does Vivitrol cause anxiety?

Anxiety is a listed side effect of Vivitrol. And, there are clinically documented case studies of panic attacks. However, some patients report improvement in anxiety symptoms and other research supports that Vivitrol does not increase anxiety.

“I got the shot 11 days ago and noticed my anxiety is practically non-existent.”

“I haven't had anxiety in years, but since I've been on Vivitrol I've had panic attacks for the first time in my life.”

If you have underlying anxiety issues or are experiencing panic attacks after taking Vivitrol, anti-anxiety medications can help. Also, mild side effects of Vivitrol tend to get better after 1-2 months even without further intervention.

Can Vivitrol cause depression?

While depression is listed as a possible adverse event, most research does not support the idea that Vivitrol causes depression. In fact, patients on Vivitrol consistently for six months have been shown to have fewer depressive symptoms than those not using Vivitrol.

It is substance abuse in general that has a high correlation with depression – whether the mental cycles of addiction caused depression or substances are used to self-medicate existing depression.

Does Vivitrol cause mood swings?

Naltrexone does not worsen mood and is actually associated with improved mood, especially when adherent to treatment over several months.

Other Mental Side Effects of Vivitrol

Research shows slightly higher rates of insomnia in patients treated with Vivitrol versus a placebo. Insomnia is also a known symptom of withdrawal in general and there are many treatments to combat this effect – whether caused by Vivitrol, withdrawals or poor sleep habits.

(See also: How to Sleep During Withdrawal article)

No, Vivitrol is most likely to not have any impact on energy levels. The effects of recently going through withdrawal or insomnia from withdrawals or as a side effect of Vivitrol may decrease energy levels.

No, naltrexone doesn’t directly make patients happy. Though, properly treating addiction will lead to an increase in happiness measures.

No, Vivitrol is not a mind-altering medication. It is non-addictive and doesn’t cause withdrawals when stopped.

Using opioids is extremely dangerous on Vivitrol because of how the medication interacts with opioid receptors in the brain. Drinking alcohol is unpleasant, but not life-threatening. 

Learn more about interactions with Vivitrol medication.

Ready to Start Vivitrol?

Symetria doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the field.

Dean, A. J., Saunders, J. B., Jones, R. T., Young, R. M., Connor, J. P., & Lawford, B. R. (2006). Does naltrexone treatment lead to depression? Findings from a randomized controlled trial in subjects with opioid dependence. Journal of psychiatry & neuroscience : JPN31(1), 38–45.

Haglund, Margaret MD*; Mooney, Larissa MD*; Gitlin, Michael MD*; Fong, Timothy MD*; Tsuang, John MD†,‡ Vivitrol and Depression, Addictive Disorders & Their Treatment: September 2014 – Volume 13 – Issue 3 – p 147-150
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Hassan, A.N., Nunes, E. Medication Treatments for Opioid Use Disorder: What Is the Impact on Mood and Mood Disorders?. Curr Addict Rep 5, 303–311 (2018).

Krupitsky, E., Zvartau, E., Blokhina, E., Verbitskaya, E., Wahlgren, V., Tsoy-Podosenin, M., Bushara, N., Burakov, A., Masalov, D., Romanova, T., Tyurina, A., Palatkin, V., Yaroslavtseva, T., Pecoraro, A., & Woody, G. (2016). Anhedonia, depression, anxiety, and craving in opiate-dependent patients stabilized on oral naltrexone or an extended-release naltrexone implant. The American journal of drug and alcohol abuse42(5), 614–620.

Mason, A. E., Laraia, B., Daubenmier, J., Hecht, F. M., Lustig, R. H., Puterman, E., Adler, N., Dallman, M., Kiernan, M., Gearhardt, A. N., & Epel, E. S. (2015). Putting the brakes on the “drive to eat”: Pilot effects of naltrexone and reward-based eating on food cravings among obese women. Eating behaviors19, 53–56.

Mitchell, M. C., Memisoglu, A., & Silverman, B. L. (2012). Hepatic safety of injectable extended-release naltrexone in patients with chronic hepatitis C and HIV infection. Journal of studies on alcohol and drugs73(6), 991–997.

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    1. Everyone is different. For some patients, the side effects resolve quickly after the first injection and do not occur on the second injection or thereafter.

      For others, the side effects are temporary and resolve but re-occur after each dose going forward to a lesser and lesser degree. 

      And finally, for some patients, the side effects tend to linger after each dose at the same severity. In these cases, patients usually stop taking the medication. We can also treat the side effects to make things more comfortable for a patient as they are settling in and adapting to each month’s injection of Vivitrol.

    1. No, it does not. If you are administered Vivitrol while still in active withdrawal, more likely than not, it will make your opioid withdrawal symptoms worse.

    1. It depends. In general, you will not experience any unpleasant effects if you were to use opioids while Vivitrol is at an effective amount in your body. Vivitrol is designed to block the other opioids from taking effect, but unfortunately, it is not foolproof. If you take a very large amount of opioids, this can potentially override Vivitrol’s blocking effect and can lead to severe respiratory depression, overdose, and death. If you were to use opioids 3-4 weeks after your last Vivitrol injection when the Vivitrol levels are lower in your system, then you can still feel the usual negative effects of opioid use (i.e. constipation, drowsiness, respiratory depression). Therefore, it is best to abstain from using any opioids while on Vivitrol, except under the specific guidance of your medical providers.

  1. I got the shot on the 3rd and the swelling has not gone away the knot has gotten bigger and it’s now the 17th should I go to the ER ?Cause it still hurt too. I believe she hit bone!

    1. I recommend contacting the medical provider who administered the injection for further evaluation. It may be possible you are having an injection site reaction, which can be due to an allergy to one or more components of Vivitrol. In rare instances, the Vivitrol injection (as with any injection) can cause a soft tissue infection, and if the infection is worsening, then it requires immediate medical treatment.

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