Vivitrol

[deleted1100659]

I know you can start naltrexone while drinking as long as they don’t have acute hepatitis/liver enzymes >3x normal but have more limited experience with vivitrol

With vivitrol they recommend you need to be detoxed completely before using it? Is it due to the fact that you can’t just stop the medication given that it’s a long acting injectable and you’re higher risk for issues if you get alcoholic hepatitis or something?

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[Penguin10]

This trial looks like it was pre-FDA approval. They treated both people actively drinking and people with at least seven days of abstinence prior to starting treatment and found higher success with abstinence, if that was consistent across trials maybe it ended up included in the approval? They don't seem to report higher adverse effects between groups.

JAMA 2005 Apr 6;293(13):1617-25. doi: 10.1001/jama.293.13.1617.
Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: A randomized controlled trial.

 

[littlefred]

Live by this motto: only avoid vivitrol/revia on patients with acute liver failure.
All others benefits outweigh the risks of transaminitis.

Check to see if you find in the literature any liver failure associated with naltrexone administration.