Both Vivitrol (naltrexone) and Suboxone (buprenorphine) are anti-craving medications used to treat substance use disorders. They are different medications, but both interact with opioid receptors in the brain.
- Vivitrol contains naltrexone, which is an opioid blocker.
- Suboxone contains buprenorphine, which is an opioid activator. (Suboxone also contains naloxone, another opioid blocker. But, the naloxone doesn't have any effect unless Suboxone is misused).
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How is Suboxone different from Vivitrol?
Suboxone does not treat alcohol use disorder.
- Vivitrol is FDA-approved to treat both alcohol and opioid use disorders.
- Suboxone is FDA-approved for only opioid use disorder.
Suboxone must be taken every day.
- Vivitrol is given as a monthly injection by a healthcare provider.
- Suboxone is taken daily and dissolves under the tongue.
Suboxone helps with withdrawals.
- Vivitrol requires up to 7-10 days of abstinence from opioids before starting; it does not treat withdrawals.
- Suboxone helps relieve withdrawal symptoms and can be started much sooner..
Suboxone should be tapered prior to stopping.
- Vivitrol does not cause dependence and can be stopped without causing withdrawal.
- Suboxone must be tapered slowly prior to stopping to avoid withdrawal.
Suboxone is a partial opioid agonist.
- Vivitrol occupies opioid receptors in the brain but does not activate them; it is not an opioid medication.
- Suboxone partially activates opioid receptors and is classified as a partial opioid agonist.
Does Suboxone work better than Vivitrol?
Once patients with opioid use disorder start either medication, their success rates are similar between Suboxone and Vivitrol.
The challenge is that Vivitrol has to be given after withdrawal is over. Getting 7-10 days detoxed from opioids can be difficult without the help of medications like Suboxone.
Therefore, Suboxone is generally cited as more successful. But, if a patient already has 7 days free of opioids (including Suboxone), then Vivitrol will be just as effective.
Both medications are great options to discuss with your doctor and both are most effective when combined with therapy like an Intensive Outpatient Program (IOP).
When is Vivitrol better than Suboxone?
One medication isn’t better than the other in general, but there are circumstances where Vivitrol might be the better option.
- For patients who also struggle with alcohol: Vivitrol (naltrexone) is FDA approved for managing alcohol and opioids cravings, so it can be a good choice for patients who struggle with both. Suboxone is not approved for treatment of alcohol use disorder alone.
- When no longer having withdrawal from opioids: If a patient has been off opioids for 7-10 days or longer, Vivitrol may be a good choice to help manage cravings. Vivitrol will not add any kind of dependence and is well tolerated with minimal Vivitrol side effects.
- In controlled settings: Vivitrol is often used in settings like inpatient rehabs or jails where patients are medically detoxed and have less acess to opioids.
- After Suboxone: Vivitrol can provide an extra layer of security after tapering off Suboxone, since it is an opioid blocker and can also prevent opioid cravings.
Is Suboxone stronger than Vivitrol?
The answer isn’t straightforward. Because Suboxone partially activates the opioid receptor, Suboxone is stronger than Vivitrol in terms of opioid effect. Though, Vivitrol actually sticks to the receptor better than Suboxone but without activating it, so the opioid effect isn’t felt by patients.
Suboxone
Partial Agonist
Vivitrol
Antagonist
Is Suboxone safer than Vivitrol?
Both medications are very safe when used as prescribed. With either medication, interactions with opioids can be dangerous and may result in overdose.
Can Suboxone be used with Vivitrol?
No, you cannot take Suboxone and Vivitrol together since they have opposing mechanisms of action for the same opioid receptors. Taking both medications at the same time can cause significant withdrawal symptoms, including nausea, vomiting, sweating and severe pain.
How can I switch from Suboxone to Vivitrol?
When a patient decides to stop taking Suboxone, Vivitrol is sometimes started to provide a safety net against illicit opioid use and cravings.
The first step is to taper off of Suboxone. The patient must then wait for all the Suboxone to be completely out of their system, which typically takes about 7-10 days after their last dose.
How long it takes to taper off Suboxone depends on the dose. Patients coming off higher doses will typically need more time. Rushing the taper can lead to unnecessary withdrawal and/or cravings.
How can I switch from Vivitrol to Suboxone?
Transitioning from Vivitrol to Suboxone may be appropriate if cravings aren’t controlled with Vivitrol.
Ideally, the patient would wait around the time of their next Vivitrol shot (around 28 days) and start Suboxone instead. The change shouldn’t cause any side effects or sickness.
A Suboxone clinic will typically offer both medications.
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