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Vivitrol vs Sublocade

Vivitrol (naltrexone) and Sublocade (buprenorphine) are medications used in addiction treatment programs. Both are approved for opioid use disorder (OUD) treatment, and both come in a once-monthly injectable format. However, important differences separate these two medications, including their active ingredients. 

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Read on to understand which medication might be right for you. 

Understanding Vivitrol & Sublocade 

Medications like naltrexone and buprenorphine are often used in medication-assisted treatment (MAT) programs for OUD. Researchers say these therapies can increase the likelihood that someone will stay in treatment. By doing so, these medications can lower the risk of overdose death.[1]

While both medications could be part of MAT, they work a little differently. 

How Does Vivitrol Work? 

Vivitrol is an injectable medication containing naltrexone, an opioid antagonist. The U.S. Food and Drug Administration (FDA) has approved Vivitrol as a treatment for both alcohol use disorder (AUD) and OUD.[4]

Vivitrol works by blocking key chemical reactions caused by alcohol and opioids. Typically, these substances latch to opioid receptors in the brain and trigger chemicals that lead to relaxation and happiness. When naltrexone is in place, alcohol and opioids can’t latch as firmly (or at all). 

When people drink or use drugs on Vivitrol, they don’t feel the same level of relaxation and euphoria. The next relapse episode may be less likely as a result. If the substances don’t work as expected, people may be less likely to use them. 

Vivitrol must be administered in a doctor’s office every month. If people skip their doses, the drug can wear off. If it does and people return to a dose of opioids they once took, they can overdose. Naltrexone can reduce your tolerance for drugs, so doses you could once tolerate could be much too strong after using Vivitrol.[2] 

Vivitrol can cause liver problems when given in too high doses. It can also cause side effects like nausea, vomiting, and injection site reactions.[4]

How Does Sublocade Work?

Sublocade is an injectable medication containing buprenorphine, a partial opioid agonist. The FDA has approved Sublocade as a treatment for OUD.[3]

The buprenorphine in Sublocade latches lightly to opioid receptors in the brain and body. When it’s connected, buprenorphine can ease opioid withdrawal symptoms (like nausea and vomiting) while reducing drug cravings. People don’t feel high on the proper dose of buprenorphine, but they’re less likely to use drugs like heroin and oxycodone.[7]

Sublocade is designed for people who have started buprenorphine treatment with oral medications and need a once-monthly option for OUD control. It must be delivered each month, and people who skip their doses can develop withdrawal symptoms like nausea and vomiting.[7]

Common side effects associated with Sublocade include constipation, headache, and nausea. It can also be hard on the liver at high doses.[7] 

While the buprenorphine in Sublocade can be intoxicating in people who don’t have OUD, the risk of abuse is low. The drug must be administered via an injection in a doctor’s office. There’s no real way to get the drug and abuse it.

Comparing Vivitrol & Sublocade 

This table can help you understand the similarities and differences between these medications:[4-9] 

Vivitrol Sublocade 
Active ingredientNaltrexone Buprenorphine 
FDA-Approved Use Alcohol use disorder and opioid use disorder Opioid use disorder 
Drug Schedule Not a controlled substance Schedule II 
Formats Available Injection Injection 
Typical dosage380 mg every 4 weeks 100 mg every 4 weeks 
Common Side EffectsNausea, vomiting, injection site reactions, muscle cramping, dizziness, sedation, and insomniaConstipation, headache, nausea, injection site reactions, vomiting, and fatigue 
Safety Concerns People with liver or kidney failure should use the medication with caution Withdrawal when the medication is discontinued, liver problems 
Addiction Potential None Low, due to the drug’s administration format 
Cost$1,000 per injection (or higher) $2,000 per injection (or higher) 
Covered by Insurance?Typically Typically 
Generic Available?NoNo
EfficacyStudy suggests Vivitrol is as effective as Suboxone in treating opioid use disorder Study suggests it’s better than placebo in helping people quit using opioids 

Key Differences Between Vivitrol & Sublocade 

While both medications can be an important part of MAT, important differences separate them. These are a few of them:

Treatment Targets

Sublocade is FDA-approved to treat OUD in people who have already used oral medications with buprenorphine.[7] Vivitrol can also treat OUD, but doctors can use these injections to help people with AUD too.[4]

Injection Sites

Both medications must be administered by a medical professional via injection. However, Sublocade is injected under the skin in a site like the abdomen.[7] Vivitrol is injected into the muscles in a site like the buttocks.[4]

Active Ingredients

Vivitrol contains naltrexone, an opioid antagonist.[4] It works by blocking the effects of opioids and alcohol. 

Sublocade contains buprenorphine, a partial opioid agonist.[7] It works by weakly binding to opioid receptors in the brain, reducing cravings and easing withdrawal symptoms. 

Ease of Quitting

Vivitrol causes no side effects when people stop using it.[4] Sublocade can cause flu-like symptoms when people stop treatment or skip a dose.[7] To stop using Sublocade, you might need to transition to an oral buprenorphine medication and taper that dose slowly. 

Choosing the Right Injection Medication for Opioid Use Disorder 

If you’re using opioid drugs and want to quit, talk honestly with your doctor about which medication is right for you. If you’re using both alcohol and opioids, Vivitrol might be best. If you’re struggling with cravings for opioids, Sublocade might be a better fit. Your doctor can help you decide which option might be best for your long-term sobriety. 

Updated March 21, 2024
Resources
  1. How effective are medications to treat opioid use disorder? National Institute on Drug Abuse. Published December 2021. Accessed February 27, 2024. 
  2. FDA issues warning letter for not including the most serious risks in advertisement for medication-assisted drug. U.S. Food and Drug Administration. Published December 11, 2019. Accessed February 27, 2024.   
  3. FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder. U.S. Food and Drug Administration. Published November 30, 2017. Accessed February 27, 2024.  
  4. Vivitrol prescribing information. U.S. Food and Drug Administration. Published October 2010. Accessed February 27, 2024. 
  5. Blau M. Long-awaited study finds monthly Vivitrol as effective as daily pill for opioid addiction. Stat. Published November 14, 2017. Accessed February 27, 2024.  
  6. Verifying insurance benefits. Vivitrol. Accessed February 27, 2024. https://www.vivitrol.com/opioid-dependence/verify-insurance-coverage
  7. Sublocade prescribing information. U.S. Food and Drug Administration. Published March 2021. Accessed February 27, 2024. 
  8. Sublocade pricing. Sublocade. Accessed February 27, 2024.  
  9. Clinical review report: Buprenorphine extended-release injection. Canadian Agency for Drugs and Technologies in Health. Published July 2019. Accessed February 27, 2024.
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