What are the side effects of Vivitrol?

Most common: injection site reactions (pain, swelling, bruising — resolves in 1-2 weeks), nausea, fatigue, decreased appetite, headache. Serious: opioid blockade (opioid pain meds won't work), rare liver toxicity, rare severe injection site reactions requiring medical attention.

Where do you get a Vivitrol injection?

Vivitrol must be administered by a healthcare provider — typically in a doctor's office, addiction treatment clinic, or participating pharmacy. Unlike naltrexone pills, you cannot give yourself the injection at home.

Can Vivitrol cause depression?

Naltrexone/Vivitrol has been associated with mood changes in some patients, though clinical trials show no consistent link to depression. Some people with existing depression report feeling emotionally blunted. If you experience mood changes, tell your prescriber — there are alternatives.

What happens if you use opioids while on Vivitrol?

Opioids (including prescription pain meds, heroin, fentanyl, cough medicines with codeine) will not work while Vivitrol is active. If you try to override the blockade with a larger opioid dose, there is serious risk of overdose when Vivitrol wears off. Always tell any treating doctor you are on Vivitrol before any procedure or surgery.

How quickly does Vivitrol start working?

Naltrexone reaches effective blood levels within 2 hours of the injection and maintains consistent levels for 28-30 days. Opioid receptor blockade is essentially immediate. Reduction in alcohol craving and drinking typically becomes noticeable within the first 1-2 weeks.

Is Vivitrol covered by Medicaid?

Yes — Vivitrol is covered by Medicaid in most states for alcohol and opioid use disorder. Coverage often requires a prior authorization documenting the diagnosis. Contact your state's Medicaid program or use the Vivitrol co-pay assistance at vivitrol.com.

What is the Vivitrol co-pay assistance program?

Alkermes (Vivitrol's manufacturer) offers a co-pay assistance program that reduces out-of-pocket cost to $0 per month for commercially insured patients who qualify. Visit vivitrol.com/coverage to see eligibility and apply.

Can you drink alcohol the day of a Vivitrol shot?

There is no medical contraindication to drinking alcohol on the day of a Vivitrol injection. The shot does not cause a reaction to alcohol. However, some providers ask patients to be sober at the appointment simply for safety during the injection procedure.

Does Vivitrol stop cravings?

Vivitrol significantly reduces craving intensity by blocking the opioid reward signal that drives drinking. In clinical trials, Vivitrol reduced heavy drinking days by 25% compared to placebo and increased the percentage of days abstinent. Cravings don't disappear entirely but are substantially diminished.

How long does a Vivitrol shot last?

A single Vivitrol injection provides continuous naltrexone release for approximately 30 days. This eliminates the need for daily oral medication and removes the barrier of remembering to take a pill. Blood levels are more stable than oral dosing, which some clinicians believe improves effectiveness.

Who is a good candidate for Vivitrol?

Vivitrol is well-suited for people who struggle with medication adherence, who want to reduce or eliminate alcohol use, and who have already completed detox (the patient must be opioid-free for 7–10 days before the first injection to avoid precipitated withdrawal). It is also used as a bridge during early recovery when daily pill-taking is most unreliable.

What are the side effects of Vivitrol injections?

The most common side effects are injection site reactions — pain, tenderness, or nodules at the injection site. Systemic side effects include nausea, decreased appetite, fatigue, and headache, similar to oral naltrexone. Injection site reactions are the most distinctive adverse effect of the injectable formulation.

Is Vivitrol covered by insurance?

Vivitrol is covered by most major insurance plans, Medicaid, and Medicare as an FDA-approved medication for alcohol use disorder and opioid dependence. The manufacturer (Alkermes) also offers a patient assistance program for uninsured or underinsured patients. Cost should not be a barrier — speak with your prescriber or pharmacist about coverage options.

Medication & Treatment

Vivitrol for Alcohol: The Monthly Shot Explained

Q: How does Vivitrol work for alcohol?

Vivitrol (extended-release naltrexone) blocks opioid receptors in the brain that mediate alcohol's rewarding effects. Without the dopamine reward signal, the compulsion to drink diminishes over time. The shot delivers consistent naltrexone levels for 28-30 days.

Q: How much does Vivitrol cost?

Vivitrol list price is approximately $1,500-1,800 per monthly injection. Most commercial insurance and Medicaid cover it when prescribed for alcohol use disorder with prior authorization. The manufacturer offers a co-pay assistance program that can reduce out-of-pocket cost to $0 for commercially insured patients.

Q: How long do you stay on Vivitrol?

Most guidelines recommend 12 months of treatment, though some patients continue longer. There is no dependence, tolerance, or withdrawal from stopping Vivitrol. The decision to stop should be made with a prescriber based on relapse risk and stability.

Q: Can you drink while on Vivitrol?

Vivitrol does not cause a reaction if you drink — unlike Antabuse (disulfiram). Drinking while on Vivitrol simply won't produce the usual reward, making drinking feel flat and unrewarding. This is the mechanism, not a side effect.

Q: Do you need to be sober to get Vivitrol?

You must be opioid-free for 7-10 days before Vivitrol to avoid precipitated opioid withdrawal. You do not need to be alcohol-free — in fact, most AUD treatment protocols allow the shot to be given while patients are still actively drinking, with the expectation that drinking will decrease after.

Q: Is Vivitrol better than naltrexone pills?

Clinical outcomes are similar when adherence is equal. Vivitrol wins on real-world adherence — one shot per month eliminates the daily pill-taking problem. Studies show significantly better treatment retention with Vivitrol than with daily oral naltrexone. Pills win on flexibility, cost, and the ability to use the Sinclair Method.

Dr. Ananya Krishnan, PhD Clinical Psychology · Reviewed September 2026

Quick Answer

Vivitrol is naltrexone in extended-release injectable form — the same drug as naltrexone pills, delivered as one shot per month. It eliminates the daily pill adherence problem and significantly improves real-world treatment retention. List price is ~$1,500/month but most insurance covers it. You don't need to be sober to start (only opioid-free for 7–10 days).

The biggest challenge with oral naltrexone isn't that it doesn't work — it's that people stop taking it. Studies show fewer than 20% of patients are still taking daily pills at 6 months. Vivitrol solves this with a once-monthly injection, maintaining consistent blood levels for 28–30 days regardless of daily willpower.

380mgnaltrexone per monthly injection

28–30days per injection

25%reduction in heavy drinking days vs placebo

2006FDA approved for alcohol use disorder

What Is Vivitrol?

Vivitrol is the brand name for extended-release injectable naltrexone, manufactured by Alkermes. It contains the same active ingredient as naltrexone pills — just in a microsphere formulation that slowly dissolves over a month after injection into the gluteal muscle (buttock).

The extended-release formulation maintains steady blood naltrexone levels without the peaks and troughs of daily oral dosing, and completely eliminates the issue of patients skipping doses when motivation is low.

Vivitrol vs Oral Naltrexone: Which Is Better?

Vivitrol (injection)

No daily pills to remember
Consistent blood levels for 30 days
Better real-world retention
Can't "cheat" by skipping before drinking
~$1,500/month list price
Must visit provider monthly
Can't use Sinclair Method
Injection site reactions

Oral Naltrexone (pills)

$20–50/month without insurance
Can use Sinclair Method
Easy to stop/adjust
Can take at home
Daily adherence required
<20% still taking at 6 months
Easy to skip before drinking
Blood levels vary with dosing

How to Get Vivitrol

Get a prescription: Any licensed prescriber can prescribe Vivitrol — GPs, addiction medicine specialists, psychiatrists, and nurse practitioners. Telehealth services can also prescribe and coordinate injection with a local provider.
Prior authorization: Most insurance requires a prior authorization documenting alcohol use disorder diagnosis. Your prescriber's office usually handles this.
Find an injection site: Vivitrol must be given by a healthcare professional. Many pharmacies (CVS, Walgreens) now administer it. SAMHSA's treatment locator (findtreatment.gov) can locate nearby providers.
Co-pay assistance: Visit vivitrol.com/coverage — Alkermes' program can reduce out-of-pocket cost to $0 for commercially insured patients who qualify.

Before your first injection: You must be opioid-free for at least 7–10 days. If opioids are present in your system when you receive Vivitrol, it will precipitate rapid, severe opioid withdrawal. This does not apply to alcohol — you do not need to be alcohol-free to start.

What to Expect at Your Appointment

The Vivitrol injection takes about 5 minutes. It's given into the gluteal muscle (upper-outer buttock) by a nurse or physician. A urine drug screen may be done beforehand to confirm opioid absence. Expect mild soreness at the injection site for 1–2 weeks.

Most people notice reduced cravings and a "flat" response to alcohol within the first 1–2 weeks after the injection. The effect is consistent throughout the month rather than peaking and fading like daily pills.

Side Effects

Injection site reactions (most common): Pain, swelling, bruising, or hardness at the injection site. Usually resolves within 2 weeks. Rarely, severe reactions can occur — contact your provider if you notice increasing pain, discharge, or open sores.
Nausea: Less common than with oral naltrexone due to slower absorption. Usually mild and resolves in the first week.
Fatigue and decreased appetite: Common in the first few weeks.
Opioid blockade: Opioid pain medications won't work for the full month. Always inform treating physicians, dentists, and anesthesiologists.
Mood changes: Some patients report emotional blunting. Tell your prescriber if this affects daily life.

Who Should Consider Vivitrol

Vivitrol is particularly well-suited for people who:

Have tried oral naltrexone but struggled with daily adherence
Know they would skip pills before a planned drinking occasion
Want the "commitment device" of a medication they can't undo
Are in early recovery with strong cravings and high relapse risk
Have Medicaid or insurance that covers it with manageable cost

Oral naltrexone may be preferable for people who want flexibility, are using the Sinclair Method, cannot afford Vivitrol's cost, or who prefer not to receive monthly injections.

Frequently Asked Questions

How does Vivitrol work for alcohol?

It blocks opioid receptors that mediate alcohol's rewarding effects. Without the dopamine reward signal, the compulsion to drink diminishes. The shot delivers consistent naltrexone levels for 28–30 days.

How much does Vivitrol cost?

List price is ~$1,500–1,800 per injection. Most commercial insurance and Medicaid cover it for AUD. The Alkermes co-pay program can reduce cost to $0 for qualifying commercially insured patients.

Do you need to be sober to get Vivitrol?

You need to be opioid-free for 7–10 days. You do not need to be alcohol-free — most protocols allow the shot while patients are still drinking, expecting drinking to decrease afterward.

Can you drink while on Vivitrol?

Vivitrol doesn't cause a reaction if you drink — unlike Antabuse. Drinking while on Vivitrol simply won't produce the usual reward, making it feel flat and unrewarding.

Is Vivitrol better than naltrexone pills?

Clinical outcomes are similar with equal adherence. Vivitrol wins on real-world retention — one shot eliminates the daily pill problem. Pills win on cost, flexibility, and the ability to use the Sinclair Method.

What if I need opioid pain meds while on Vivitrol?

Opioids won't work for the full month. For planned procedures, discuss with your prescriber — naltrexone can sometimes be discontinued in advance. Always tell surgeons and anesthesiologists you're on Vivitrol before any procedure.

Is Vivitrol FDA-approved for alcohol?

Yes — FDA approved Vivitrol for alcohol dependence in 2006. It's one of three FDA-approved medications for alcohol use disorder, alongside oral naltrexone and acamprosate.

How long do you stay on Vivitrol?

Most guidelines recommend 12 months. There's no dependence or withdrawal from stopping. Some patients continue longer based on relapse risk and their prescriber's guidance.

Track your recovery journey

Forge helps you track sobriety, log cravings, and stay accountable — whether you're on Vivitrol, oral naltrexone, or going it alone.

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