Vivitrol Question

[fishdoc]

The longer Vivitrol stays in the syringe, the thicker it becomes. It becomes like paste and might not pass through the needle.

We have patients bring a 50 mg tablet cut into quarters by the pharmacy on the day of induction. The patient takes one quarter and gets Vivitrol if there is no withdrawal. If there is withdrawal, they come back one or 2 days later and the procedure is repeated.

[DrBranton]

My understanding is that Vivitrol must be injected within one hour of being reconstituted. I agree with and appreciate the oral Naltrexone advice however, I would likely administer a 12.5 or 25mg dose.

DrB

[NoDrugs4u]

I would bill the patient for the $1500. Consider it a Stupidity Fee.

[tdbailey]

I'm not sure how long the Vivitrol 'stays good' once reconstituted but would have tried to get a 50mg PO Naltrexone to try with the patient first. If he did fine with this I would have been fine with the injection. If he did have withdrawal with the tablet at least it would have 'worn off' relatively soon.

(We usually do this when we first start pts on Vivitrol anyway to ensure enough time has elapsed since last use. I write for one tablet and the pt fills it at the pharmacy the same time they fill the shot)

[DrBallester]

Consider sending the question to Dr. A. Bisaga

If you cannot do an oral naltrexone challenge, let the patient decide to take the risk of potential precipitated withdrawal.