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Subutex vs Vivitrol
Introduction
For patients battling opioid addiction, certain drugs that interact with the brain's opioid receptors can aid in easing withdrawal symptoms and promoting recovery. Subutex and Vivitrol are two such medications frequently prescribed for this purpose. They each affect different aspects of the body’s response to opioids, but both ultimately aim to help individuals overcome their dependency. Subutex is a partial opioid agonist, meaning it activates the opioid receptors in the brain but produces only a partial response compared to full opioids. This helps reduce cravings without producing the same high or dangerous side effects as other opioids might do. On the other hand, Vivitrol is an opioid antagonist medication; it blocks these receptors entirely to prevent any feelings associated with drug use from occurring at all - effectively eliminating any potential 'reward' from substance misuse.
What is Subutex?
Buprenorphine (the generic name for Subutex) was a significant advancement in the class of drugs used to treat opioid addiction. It was first approved by the FDA in 2002. Subutex is a partial agonist that binds to opioid receptors, thus reducing cravings and withdrawal symptoms associated with opioid dependency without producing the high or dangerous side effects of other opioids.
On the other hand, Naltrexone (the generic name for Vivitrol), which was approved by the FDA in 1984, is an antagonist that blocks opioid receptors completely, preventing any effect if opiates are used while it's active in one's system. Both medications are valuable tools used for treating substance use disorders but they work differently.
Subutex primarily helps reduce cravings and eases withdrawal during detoxification process whereas Vivitrol is more often used as part of a long-term maintenance plan after initial detoxification has been completed due its ability to block the euphoric effects should relapse occur. The choice between these two medications will typically depend on specific patient needs and circumstances.
What conditions is Subutex approved to treat?
Subutex and Vivitrol are approved for the treatment of opioid use disorder:
- Subutex (buprenorphine) is used as a part of medication-assisted therapy (MAT), particularly in managing opioid withdrawal symptoms, to reduce the potential for misuse.
- Vivitrol (naltrexone) is typically utilized once detoxification has occurred, to prevent relapse by blocking opiate receptors in the brain, making it impossible to feel opiate effects.
How does Subutex help with these illnesses?
Subutex helps manage opioid addiction by reducing withdrawal symptoms and cravings. It does this through its active ingredient buprenorphine, a partial opioid agonist that binds to the same receptors in the brain as opioids do but with less intensity. This effectively decreases the euphoric feelings and physical dependence that opioids can create, helping individuals maintain abstinence from these drugs.
Vivitrol, on the other hand, contains naltrexone - an opioid antagonist. Instead of activating opioid receptors like Subutex does, Vivitrol blocks them completely which prevents any effects if someone uses an opioid drug. Both medications serve different roles in recovery: Subutex can be used during detoxification to help manage withdrawal symptoms while Vivitrol is typically used post-detoxification to prevent relapses.
Opioid use disorder is often characterized by intense cravings for opioids and unpleasant withdrawal symptoms when not using them. Therefore, by either reducing these cravings or blocking effects of opioids altogether, both Subutex and Vivitrol play crucial roles in managing this condition and aiding recovery.
What is Vivitrol?
Vivitrol, the brand name for naltrexone, is an opioid antagonist that works by binding to opioid receptors and blocking the effects of opioids like heroin or prescription painkillers. It reduces cravings and prevents euphoria if a person does use drugs while on treatment. Unlike Subutex (buprenorphine), Vivitrol doesn't produce any opioid-like effects itself, so it has no potential for abuse or physical dependence. Naltrexone was first approved by the FDA in 1984 to treat opiate addiction but under its injectable form as Vivitrol, it got approval in 2010 specifically for treating alcoholism and preventing relapse to opioid dependency after detoxification. Its action on neurotransmitters means that its side-effect profile is different than that of buprenorphine-based medications such as Subutex — notably less risk of respiratory distress, a common significant side effect from other opioids. The blockage effect can be beneficial especially for patients who have completed detoxification and are highly motivated towards maintaining abstinence from their drug of choice.
What conditions is Vivitrol approved to treat?
Vivitrol, a long-acting injectable form of naltrexone, is approved for the treatment of:
- Opioid dependence after opioid detoxification
- Alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment.
It's important to note that Vivitrol should be part of a comprehensive management program that includes psychosocial support.
How does Vivitrol help with these illnesses?
Vivitrol, like Subutex, plays a significant role in the management of opioid dependence. It works by blocking the effects of opioids in the brain and thereby reducing cravings and withdrawal symptoms which can lead to relapse. Vivitrol acts as an opioid antagonist, binding to opioid receptors in the brain but not activating them, effectively preventing any 'high' or euphoria that might otherwise be induced by drug use. Unlike Subutex, which is taken daily and can potentially be misused or cause dependency due to its partial agonist properties, Vivitrol is administered monthly via injection under medical supervision. This reduces potential misuse while ensuring patients adhere to their medication regime - key factors when tackling addiction recovery.
How effective are both Subutex and Vivitrol?
Both buprenorphine (Subutex) and naltrexone (Vivitrol) have proven effectiveness in treating opioid dependence, both were approved by the FDA within a decade of each other. Naltrexone was initially approved for treating opioid addiction in 1984 and buprenorphine received its approval in 2002. However, they act on different receptors and thus may be prescribed under varying circumstances. Buprenorphine is a partial agonist at the mu-opioid receptor, while naltrexone acts as an antagonist at this same receptor.
The efficacy of Subutex compared to Vivitrol was directly studied in a double-blind clinical trial conducted over 24 weeks; these two medications exhibited similar success rates at managing symptoms of withdrawal and cravings, but showed diverging safety profiles with more adverse events reported with Vivitrol use.
A review from 2010 demonstrated that Subutex is effective starting from the first week of treatment, has a favorable side-effect profile when compared to methadone or full-agonists like heroin itself, and it's well-tolerated across diverse populations including pregnant women. The optimal dose varies quite widely depending on individual tolerance levels - generally ranging between 8mg/day up to as high as 32mg/day for some patients experiencing severe symptoms.
Vivitrol similarly shows promising results according to a meta-analysis published in Addiction Biology journal during late 2017 which suggested it can be more effective than placebo for preventing relapse into opioid misuse after detoxification - especially among highly motivated individuals due to its once-monthly administration regimen that simplifies adherence considerably. Despite this advantage though it's still typically considered alongside or only after other forms of medication-assisted treatment such as Suboxone or Methadone due largely because acute withdrawal must be fully resolved prior initiating therapy with Vivitrol unlike other options where transitioning can occur sooner.
At what dose is Subutex typically prescribed?
Dosages of Subutex, a sublingual tablet for treating opioid dependence, typically start at 8-16 mg/day during the initial phase and are adjusted in increments/decrements of 2 to 4 mg/day. The target dose is generally between 12-24 mg/day based on how well the patient responds. For Vivitrol, an injection administered by healthcare professionals used to prevent relapse in people who became dependent on opioid medicine and then stopped using it, the recommended dosage is one intramuscular injection of 380mg once per month. In all cases with these medications, doctor's instructions should be strictly adhered to due to their potential addictive qualities and other serious health risks if misused.
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At what dose is Vivitrol typically prescribed?
Vivitrol therapy typically begins with detoxification from opioids and is then followed by an initial dosage of 380 mg, administered intramuscularly in the buttocks once every four weeks. This can be adjusted as needed based on clinical response, but it should not exceed 380 mg per month. The injection needs to be given by a healthcare professional and is usually performed in a controlled clinical setting. It's important to remember that missing doses or discontinuing treatment prematurely may lead to relapse into opioid abuse, so adherence to the monthly schedule is critical for sustained recovery.
What are the most common side effects for Subutex?
Common side effects of Subutex (buprenorphine) may include:
- Nausea and vomiting
- Constipation
- Sweating
- Headache and mild dizziness
- Insomnia, or sleeplessness
- Swelling in your hands or feet
- Feeling drunk, or experiencing a sensation similar to being intoxicated
On the other hand, Vivitrol (naltrexone) can cause some different side effects such as:
- Nausea and vomiting
- Diarrhea
- Headache
- Dizziness or faintness
- Anxiety and restlessness
-Tiredness/ fatigue
-Stomach cramps/pain
-Joint/muscle pain
-Decreased appetite.
It's important to note that both medications are used for treating opioid addiction but work in different ways and should be taken under the supervision of a healthcare professional.
Are there any potential serious side effects for Subutex?
While both Subutex and Vivitrol are medications used to treat opioid dependence, their side effects can differ. In rare cases, serious side effects can occur with both drugs:
- Suicidal thoughts or self-harm tendencies
- Signs of allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions such as blistering and peeling accompanied by fever and sore throat
- Vision disturbances: blurred vision, tunnel vision, eye pain or seeing halos around lights;
- Cardiovascular issues: fast heartbeats, chest fluttering sensation, shortness of breath and dizziness (like you might pass out)
For Subutex specifically:
- You may experience low blood pressure which presents as feeling light-headed upon standing up
For Vivitrol specifically:
- Liver damage symptoms including yellowing eyes/skin (jaundice), dark urine or abdominal pain
If you experience signs of a severe nervous system reaction like muscle rigidity, high fever sweating confusion rapid heart rate tremors faintness; any symptoms indicating serotonin syndrome such as agitation hallucinations fever excessive sweating shivering swift heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea then seek immediate medical attention.
What are the most common side effects for Vivitrol?
The use of Vivitrol can result in various side effects, which may include:
- Nausea or vomiting, loss of appetite
- Stomach pain
- Cold symptoms such as stuffy nose, sneezing, and sore throat
- Dizziness or feeling nervous
- Sleep problems (insomnia)
- Muscle or joint pain
- Unusual tiredness or weakness
- Changes in skin color at the injection site Anxiety and restlessness are other possible reactions. It's also important to note that some people experience more serious side effects like confusion, hallucinations, blurred vision, a fast heartbeat or even signs of liver disease such as yellowing eyes/skin. As with any medication decision-making process it is essential to weigh these potential negative consequences against the therapeutic benefits alongside your healthcare provider.
Are there any potential serious side effects for Vivitrol?
For individuals considering Vivitrol, potential side effects can vary. Serious adverse reactions may include:
- Symptoms of an allergic reaction such as hives, difficulty breathing, swelling of your face or throat
- Mood changes including depression and suicidal thoughts
- A sudden opioid withdrawal symptom if you've used opioid drugs within the past 7 to 14 days
- Liver damage symptoms which might show up as yellowing eyes/skin (jaundice), dark urine, stomach pain
- Pneumonia symptoms like chest pain, cough with mucus and trouble breathing
- Signs of a severe skin reaction that includes fever, sore mouth/throat/eyes, rash with blistering and peeling.
If any of these occur after taking Vivitrol it's crucial to seek immediate medical attention. Additionally remember not to consume alcohol when using this medication due to potential harm.
Contraindications for Subutex and Vivitrol?
Both Subutex and Vivitrol, like all medications used in the treatment of opioid addiction, can have serious side effects. If you notice any severe physical or mental changes after taking these medications, please seek immediate medical attention.
Neither Subutex nor Vivitrol should be taken if you are currently using opioids or have a high level of opioids in your system. This is because an abrupt withdrawal from opioids can cause severe withdrawal symptoms. Your doctor needs to confirm that you are opioid-free before starting either medication; with Subutex it typically takes around 12-24 hours after last opioid use while for Vivitrol it requires seven to ten days of abstinence from opioids.
Always inform your healthcare provider about any other medications you're taking as some may interact harmfully with Subutex and Vivitrol. For example, benzodiazepines and other central nervous system depressants such as alcohol can increase the risk of overdose death when combined with these treatments.
How much do Subutex and Vivitrol cost?
For the brand name versions of these drugs:
- The price of 30 sublingual tablets of Subutex (2 mg) averages around $125, which works out to approximately $4.16/day for a single daily dose.
- The price of one injection (380 mg) of Vivitrol is about $1,300, and since it's administered once per month, that works out to approximately $43/day.
Therefore, if you require a larger dosage range for Subutex (i.e., 8 mg/day or higher), then brand-name Vivitrol may be less expensive on a per-day treatment basis. However, note that cost should not be your primary factor when determining which medication is suitable for you.
For the generic version of these medications:
- Buprenorphine - the active ingredient in Subutex - varies in price but can range from about $50-$200 for 30 sublingual tablets at doses between 2mg and 8mg. This equates to roughly between $1.66 and up to over $6 per day depending on dosage.
- Naltrexone – found in Vivitrol – comes as an oral tablet with prices ranging from around $.70-$2 per tablet ($21-$60/month). Note though this doesn't account for the injectable form used in Vivitrol treatment which has similar costs to its branded counterpart due to lack of generics.
Popularity of Subutex and Vivitrol
Buprenorphine, including brand versions such as Subutex, was estimated to have been prescribed to about 1.7 million people in the US in 2020. Buprenorphine accounted for just over 50% of opioid dependency treatment prescriptions in the US. It is a key player amongst medications used for treating opiate addiction and its prescription rate has generally increased since its approval by FDA in 2002.
Naltrexone, under brand name Vivitrol, was prescribed to approximately 164 thousand people in the USA during the same period. Vivitrol accounts for approximately 8% of total drug therapy treatments for alcohol and opioid dependence. In contrast to Subutex which requires daily administration, Vivitrol is administered monthly via injection making it a convenient choice but also more expensive than other options. The prevalence of naltrexone has seen significant growth over time with an overall increase in awareness and acceptance towards addiction treatment drugs.
Conclusion
Both Subutex (buprenorphine) and Vivitrol (naltrexone) are well-established medications used in the treatment of opioid dependency, with numerous clinical studies supporting their usage over placebo treatments. In some cases, these two drugs may be utilized in tandem under careful supervision by a healthcare professional. However, they possess different mechanisms of action; Subutex is an opioid agonist that helps to curb withdrawal symptoms and cravings by binding to the same receptors as opioids but without inducing a significant euphoric high, while Vivitrol is an opioid antagonist that blocks the effects of opioids altogether.
Subutex can be initiated shortly after cessation from short-acting opioids while patients must be free from all types of opioids for at least 7-10 days before they start taking Vivitrol to avoid precipitated withdrawal. This means there's often quite a bit more initial discomfort involved when starting on Vivitrol compared to buprenorphine.
Both medications are available in generic form which represents considerable cost savings for patients who need to pay out-of-pocket. The onset or adjustment period for both drugs varies - immediate relief from withdrawal symptoms with Subutex versus delayed relief with Vivitrol due its monthly injection format.
While both drugs generally have good tolerability profiles, side effects do occur and differ between the two: common ones include constipation and nausea with Subutex versus potential liver damage and depression with Vivitrol. For both drugs, it's crucial that patients closely monitor their physical health status along this recovery journey and seek immediate medical attention if they experience severe withdrawal or unusual symptoms.