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).
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.
Abstinent Days (During 144 Day Period)
| Suboxone | Vivitrol |
| 81 Days | 39 Days |
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 access 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.
Get Anti-Craving Medications
6 Comments
Ok, this is interesting. So aside from Vivitrol and suboxone having those differences, is Vivitrol similar to Sublocade (the shot you’d take once a month)?
Sublocade is a once-monthly injection of buprenorphine, which is the active ingredient in Suboxone. So think of Sublocade working the same way as Suboxone would, just without the daily dosing. Vivitrol and Sublocade bind very differently to the mu-opioid receptor. Vivitrol does not cause constipation, whereas Sublocade still can. However, Vivitrol does not help with opioid cravings, whereas Sublocade will.
I cold-trukeyed Norco in August. When into PAWS. A psych doctor wants me to try Suboxone to stop withdrawals! She says it will stop them. She is going to give this for one month, then taper me off! Will this work?
Suboxone is very effective at treating Post Acute Withdrawal Syndrome (PAWS). You may need it for longer than 1 month to allow your brain more time to adjust and heal. If the PAWS symptoms start returning during your taper, be sure to let your prescriber know so that they can pause your taper and continue the medication longer.
I have been tapering off Suboxone for 9 months now and I was on 1 mg an I wanted to stop so four days ago my doctor gave me a medicine called Lucemyra take 3every 5 hours that’s morning noon and night and it’s helping me but knocks me out I am going through withdrawals but not much because I have tapered off Suboxone pieces by piece every two weeks it worked for me but it has taken 9 mg to get here and I wanted to know how much longer before I can receive the Vivitrol shot because I am very weak I’ve been drinking and eating but this Lucemyra medicine help withdrawal but knocks me out I have family with me I’m not alone but I’m very dizzy when I stand up so I have to sit a lot so please tell me when you think I can receive the Vivitrol shot to stop the withdrawal of Suboxone I was on very small dose so please let me know please
The longer you are on Suboxone, the longer it usually takes to taper off of it completely. If you have been on it for several years, then it can often take a full 12 months to taper off of it entirely. You can always taper faster, but there is a higher likelihood you will experience withdrawal. You will need to be off of the Suboxone for at least 7 days before you can receive the Vivitrol injection. Regarding the Lucemyra, I’m sorry you are having that experience with it. It can sometimes cause dizziness and lightheadedness because it can lower your blood pressure. First I would try to take a lower dose. If you are still feeling the dizziness/wooziness with it, then reach out to your prescriber and ask if they can switch to a different medication to help with withdrawal. Lucemyra is usually a good medication that addresses the majority of opioid withdrawal symptoms, but you may tolerate side effects better if you had separate medications for your symptoms (i.e. trazodone for insomnia/restlessness, hydroxyzine for anxiety, Imodium AD for abdominal cramping/diarrhea, etc).