For alcohol dependence, the first injection is for a patient who can abstain in an outpatient setting and is not actively drinking at administration. Every patient needs an opioid exposure review, even when alcohol is the reason for treatment. Pain medicines, tramadol, methadone, buprenorphine and opioid-containing cough or diarrhea remedies matter. Current opioid dependence, acute opioid withdrawal, a positive opioid urine screen or a failed naloxone challenge are label contraindications. Liver history and pregnancy require individual review.
The clinician asks about the last drink, alcohol withdrawal history and recent opioids. Prior seizures, confusion or severe withdrawal may require medical withdrawal care before a relapse-prevention discussion. For opioid treatment, simply counting days since last use cannot prove that the injection is safe.
Bring all prescriptions, nonprescription medicines and supplements. Discuss surgery, dental work, chronic pain and emergency pain plans. Naltrexone can block opioid analgesia. A negative urine result or a tolerated test does not guarantee that precipitated withdrawal is impossible, so the whole history matters.
A healthcare provider prepares Vivitrol and gives a deep intramuscular injection into the buttock. It is not a self-injection and is not interchangeable with an oral tablet. Oral naltrexone pretreatment is not required by the label, although the clinician may discuss prior experience or another supervised step.
Discuss triggers, sleep, mood, counseling and what to do if drinking or opioid use returns. Set the next injection date and identify who handles a gap in medication delivery. Recovery needs can change even when injections are on schedule, so follow-up should assess life outside the appointment too.
Starting too soon after opioids can cause sudden, severe withdrawal that may need hospital care. The label generally recommends at least seven to ten opioid-free days after short-acting opioids; vulnerability after buprenorphine or methadone may last longer. Your clinician determines readiness. Never try to overcome the blockade with larger opioid amounts. Overdose risk rises as the injection wears off, after a missed dose or after stopping because opioid tolerance may be lower. Seek prompt assessment for worsening injection-site swelling, open wounds, jaundice, dark urine or severe abdominal pain. Call 911 for an overdose or another medical emergency.