Intramuscular extended‐release naltrexone: current evidence

Abstract

Extended-release naltrexone (XR-NTX; Vivitrol), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with ≥ 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.

Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone

“…The present study extends these findings, by showing that PDMP inquiry can be utilized as a repeated measure for treatment outcome monitoring. We examined a population of patients selected by the sole criterion that they had received one or more doses of long‐acting injectable naltrexone (INTX) (trade name Vivitrol; 380 mg IM) within a 12‐month study window, for FDA‐approved indications of opioid and/or alcohol use disorder 19. The study cohort of 68 patients was thus naturalistically composed of three subgroups determined by their INTX diagnostic indication of having either (i) alcohol; (ii) opioid, or (iii) combined alcohol and opioid use disorders.…”

Efficacy of Medications Approved for the Treatment of Alcohol Dependence and Alcohol Withdrawal Syndrome in Female Patients: A Descriptive Review

“…Its mechanism of action is not fully understood [2] . As the rewarding effects of alcohol are partly mediated through the opioid receptors, blocking of these receptors could explain the reduction in reward effects induced by alcohol consumption and subsequently the reductions in intake and cravings for alcohol [6] . Concerns about low adherence for oral formulations led to the development of slow-release formulations of naltrexone [6] .…”

Extended-release naltrexone and drug treatment courts: Policy and evidence for implementing an evidence-based treatment

“…Medication-assisted treatment (MAT) -medications for treating substance dependence paired with psychosocial treatment -demonstrates strong benefits in achieving abstinence and long-term recovery in both general and justice-involved community populations (O'Brien, 2008;Minozzi et al, 2011;Mattick, Breen, Kimber, & Davoli, 2014;Mattick, Breen, Kimber, & Davoli, 2009;Rösner et al, 2010;Kennedy et al, 2010;Bouza, Angeles, Muñoz, & Amate, 2004;Boothby & Doering, 2005;Jørgensen, Pedersen, & Tønnesen, 2011;Anton et al, 2006;Gastfriend, 2011;Pettinati et al, 2011;Krupitsky et al, 2011;Schwappach et al, 2012;Connock et al, 2007;Walters, Connor, Feeney, & Young, 2009;Zarkin et al, 2008;Finigan, Perkins, Zold-Kilbourn, Parks, & Stringer, 2011;Gryczynski et al, 2012;Lee et al, 2012;Lee et al, 2016). But it is also a mode of treatment that has been vastly underutilized, especially in justice-involved populations (Knudsen, Abraham, & Roman, 2011;Friedmann et al, 2012;Schmidt et al, 2012;Mitchell et al, 2016;Matusow et al, 2013).…”