Vivitrol and Pregnancy: What to Know
What is known about using Vivitrol (naltrexone) during pregnancy, the considerations involved, how it compares to other options, and why decisions must be individualised with your doctor.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Vivitrol is a brand name for extended-release injectable naltrexone, a medication used to treat opioid use disorder and alcohol use disorder. It works differently from opioid-based treatments: naltrexone is an opioid blocker (antagonist) that blocks the effects of opioids and helps reduce cravings, without being an opioid itself. Using Vivitrol during pregnancy is a nuanced area, and there is no simple yes or no answer; decisions must be made individually with your healthcare team, weighing the risks and benefits for each person. There is less research on naltrexone in pregnancy than on the established opioid-based treatments (methadone and buprenorphine), which are the standard, well-studied medications for opioid use disorder in pregnancy and are generally recommended, and which, unlike naltrexone, are opioid medications and can cause neonatal abstinence syndrome (a treatable withdrawal in the newborn). Naltrexone does not cause neonatal abstinence syndrome, and some evidence and clinical experience support its use in pregnancy in certain situations, particularly for women already stable on it, but the decision requires careful, individualised discussion of the risks and benefits with an obstetrician and addiction specialist. The key message is that opioid or alcohol use disorder in pregnancy must be treated, and that the right medication should be chosen together with your doctor. If you are pregnant and have a substance use disorder, seek specialist care.
Vivitrol and pregnancy: an individualised decision
Vivitrol is a brand name for extended-release injectable naltrexone, a medication given as a monthly injection to treat opioid use disorder (opioid addiction) and alcohol use disorder. It works differently from opioid-based treatments such as methadone and buprenorphine: naltrexone is an opioid antagonist, or opioid blocker, meaning it blocks the effects of opioids at the brain’s opioid receptors, and it helps reduce cravings, without being an opioid itself. This means that, unlike methadone and buprenorphine, naltrexone does not activate opioid receptors and does not cause physical opioid dependence. A common and important question is whether Vivitrol can or should be used during pregnancy. This is a genuinely nuanced area of medicine, and there is no simple, universal yes or no answer; the decision must be made individually, with a person’s healthcare team, weighing the specific risks and benefits for that woman and pregnancy.
This article explains what is known about using Vivitrol (naltrexone) during pregnancy, the considerations involved, how it compares to other options, and why decisions must be individualised with your doctor. The central message is that using naltrexone in pregnancy is a complex, individualised decision that should be made together with an obstetrician and an addiction specialist, weighing the risks and benefits, and that this is different from the well-established opioid-based treatments (methadone and buprenorphine) that are the standard, well-studied medications for opioid use disorder in pregnancy. It is crucial to understand, above all, that opioid or alcohol use disorder in pregnancy must be treated, because untreated addiction poses serious risks to both mother and baby, and that the goal is to choose the safest, most effective approach for each person. This article provides general information; it is not a substitute for individualised medical advice, and anyone who is pregnant with a substance use disorder should seek specialist care.
Naltrexone versus the standard opioid-use-disorder treatments in pregnancy
To understand the considerations around Vivitrol in pregnancy, it helps to know how it compares with the standard treatments for opioid use disorder in pregnancy. The established, well-studied medications for opioid use disorder during pregnancy are methadone and buprenorphine, both of which are opioid-based (methadone is a full opioid agonist; buprenorphine is a partial agonist). These are generally recommended as the standard of care for pregnant women with opioid use disorder, because there is substantial research and long clinical experience supporting their safety and benefits in pregnancy, and because they effectively stabilise the mother, reduce illicit opioid use and overdose risk, and improve outcomes for both mother and baby. One known effect of these opioid-based medications is that the baby may be born with neonatal abstinence syndrome (also called neonatal opioid withdrawal syndrome), a treatable withdrawal in the newborn, which is anticipated and managed by the medical team and does not outweigh the substantial benefits of treatment.
Naltrexone (Vivitrol) is different. Because it is an opioid blocker rather than an opioid, it does not cause physical opioid dependence in the mother, and, importantly, it does not cause neonatal abstinence syndrome in the baby, since the baby is not exposed to an opioid. This is sometimes seen as a potential advantage. However, there is considerably less research on naltrexone in pregnancy than on methadone and buprenorphine, so its safety profile in pregnancy is less well established, and it has not been as extensively studied. In addition, naltrexone requires a person to be fully off opioids before starting (because it will precipitate withdrawal if opioids are present), which involves a period of detoxification that carries its own considerations in pregnancy, and it depends on the person being able to maintain opioid-free, which is a different treatment model from the maintenance approach of methadone and buprenorphine. Because of these differences, methadone and buprenorphine remain the standard, recommended treatments in pregnancy, while naltrexone is used more selectively. The choice between these options in pregnancy is a careful, individualised decision made with specialists, weighing the evidence, the individual’s situation, and the risks and benefits of each.
| Aspect | Detail |
|---|---|
| Vivitrol is | Extended-release injectable naltrexone (an opioid blocker) |
| Used for | Opioid use disorder and alcohol use disorder |
| In pregnancy | Nuanced; individualised decision with your doctors |
| Standard OUD treatments | Methadone and buprenorphine (well-studied, recommended) |
| Naltrexone and the baby | Does not cause neonatal abstinence syndrome |
| But | Less research in pregnancy; requires being opioid-free first |
Considerations and why individualised decisions matter
Whether Vivitrol (naltrexone) is appropriate in a particular pregnancy depends on many individual factors, which is why the decision must be made with a person’s healthcare team rather than by a general rule. Considerations include: the fact that there is less safety data on naltrexone in pregnancy than on the standard treatments; the potential advantage that naltrexone does not cause neonatal abstinence syndrome; the person’s individual circumstances, such as whether they are already stable on naltrexone or are considering starting it; the challenges of starting naltrexone in pregnancy (which requires being fully off opioids first, involving a detoxification period that must be carefully considered in pregnancy); the risk of relapse, since if a person on naltrexone stops the medication and returns to opioid use, they may have reduced tolerance and be at higher overdose risk; and the overriding importance of effectively treating the addiction to protect both mother and baby. Some evidence and clinical experience support continuing naltrexone in pregnancy for women who are already stable on it and doing well, and there is growing interest in its use, but the evidence base remains more limited than for methadone and buprenorphine.
Because of all this, the decision about using Vivitrol in pregnancy should be made through careful, individualised discussion of the risks and benefits with the woman’s healthcare team, ideally including both an obstetrician (or maternal-fetal medicine specialist) and an addiction specialist, who can weigh the specific situation, the available evidence, and the person’s needs and preferences. This shared decision-making is essential, and there is no substitute for it. Crucially, whatever medication is chosen, the priority is that opioid or alcohol use disorder in pregnancy is treated, because untreated addiction poses serious risks to both mother and baby, including the dangers of continued substance use, overdose, and the harms of an unstable, untreated condition. Stopping treatment or not treating the addiction is generally far more dangerous than the considerations around any particular medication. The key messages are that Vivitrol (naltrexone) in pregnancy is a nuanced, individualised decision, that methadone and buprenorphine remain the standard, well-studied treatments for opioid use disorder in pregnancy while naltrexone is used more selectively and does not cause neonatal abstinence syndrome, that the decision must be made together with an obstetrician and addiction specialist weighing risks and benefits, and that, above all, substance use disorder in pregnancy must be treated. If you are pregnant and have an opioid or alcohol use disorder, seeking specialist care is essential, and effective, safe treatment options exist.
Summary
Vivitrol is a brand name for extended-release injectable naltrexone, a medication used to treat opioid use disorder and alcohol use disorder. It works differently from opioid-based treatments: naltrexone is an opioid blocker (antagonist) that blocks the effects of opioids and helps reduce cravings, without being an opioid itself. Using Vivitrol during pregnancy is a nuanced area, and there is no simple yes or no answer; decisions must be made individually with your healthcare team, weighing the risks and benefits for each person. There is less research on naltrexone in pregnancy than on the established opioid-based treatments (methadone and buprenorphine), which are the standard, well-studied medications for opioid use disorder in pregnancy and are generally recommended, and which, unlike naltrexone, are opioid medications and can cause neonatal abstinence syndrome (a treatable withdrawal in the newborn). Naltrexone does not cause neonatal abstinence syndrome, and some evidence and clinical experience support its use in pregnancy in certain situations, particularly for women already stable on it, but the decision requires careful, individualised discussion of the risks and benefits with an obstetrician and addiction specialist. The key message is that opioid or alcohol use disorder in pregnancy must be treated, and that the right medication should be chosen together with your doctor. If you are pregnant and have a substance use disorder, seek specialist care.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “When a pregnant patient asks me about Vivitrol, I resist the urge to give a one-word answer, because there isn’t one. Naltrexone is appealing in pregnancy for one clear reason: the baby is not exposed to an opioid, so there is no neonatal withdrawal to manage. But we have far more evidence for methadone and buprenorphine in pregnancy, and those remain the standard of care. Where I do consider naltrexone is often the woman who is already stable on it and thriving. The real headline, though, is bigger than which drug: an opioid or alcohol addiction in pregnancy has to be treated, full stop, because untreated is the truly dangerous option. So this is a decision to make carefully, together, with your obstetrician and an addiction specialist.”
Frequently asked questions
Can you use Vivitrol during pregnancy?
Vivitrol (naltrexone) can be used during pregnancy in some situations, but it is a nuanced, individualised decision that must be made with your healthcare team, and there is no simple universal yes or no answer. There is less research on naltrexone in pregnancy than on the established opioid-based treatments (methadone and buprenorphine), which are the standard, well-studied, and generally recommended medications for opioid use disorder in pregnancy. Naltrexone works differently, as an opioid blocker rather than an opioid, so it does not cause neonatal abstinence syndrome in the baby, which is sometimes seen as a potential advantage, but its safety profile in pregnancy is less well established. Some evidence and clinical experience support its use in pregnancy in certain situations, particularly for women who are already stable on it and doing well. Because of these complexities, the decision about using Vivitrol in pregnancy should be made through careful discussion of the risks and benefits with an obstetrician and an addiction specialist, tailored to the individual. Above all, whatever the choice, opioid or alcohol use disorder in pregnancy must be treated, because untreated addiction is dangerous for both mother and baby. So if you are pregnant and taking or considering Vivitrol, discuss it with your specialists rather than making changes on your own.
Is Vivitrol safe for the baby?
The safety of Vivitrol (naltrexone) for the baby in pregnancy is not as thoroughly established as that of the standard treatments, which is part of why its use is an individualised decision. There is less research on naltrexone in pregnancy than on methadone and buprenorphine, so there is less data on its effects on the baby. One point in its favour is that, because naltrexone is an opioid blocker rather than an opioid, it does not expose the baby to an opioid and does not cause neonatal abstinence syndrome (the treatable newborn withdrawal that can occur with opioid-based treatments). However, the more limited evidence base means that its safety cannot be characterised as fully as that of the well-studied options. Some evidence and clinical experience, particularly with women already stable on naltrexone, have not shown major concerns, and there is growing interest in its use, but more research is ongoing. Because of this, whether naltrexone is the right and safest choice for a particular pregnancy depends on the individual situation and must be weighed carefully with specialists. It is important to remember that the alternative of untreated opioid or alcohol addiction carries serious, well-established dangers for the baby, so treating the addiction is essential; the question is which treatment is safest and most appropriate for that person, which is decided with an obstetrician and addiction specialist. Individualised medical advice is essential here.
How does naltrexone differ from methadone and buprenorphine?
Naltrexone differs fundamentally from methadone and buprenorphine in how it works. Naltrexone (as Vivitrol) is an opioid antagonist, or opioid blocker: it blocks the effects of opioids at the brain’s opioid receptors and helps reduce cravings, without being an opioid itself, so it does not activate opioid receptors and does not cause physical opioid dependence. Methadone and buprenorphine, by contrast, are opioid-based medications (methadone is a full opioid agonist; buprenorphine is a partial agonist) that activate opioid receptors in a controlled way to relieve cravings and withdrawal, following a maintenance model. Several practical differences follow. Because methadone and buprenorphine are opioids, a baby exposed to them in pregnancy may be born with neonatal abstinence syndrome (a treatable withdrawal), whereas naltrexone, not being an opioid, does not cause this. Naltrexone requires a person to be fully off opioids before starting (or it will precipitate withdrawal), involving a detoxification period, and works by blocking opioids and relying on the person staying opioid-free; methadone and buprenorphine can be started while a person is still dependent and stabilise them on the medication. In pregnancy specifically, methadone and buprenorphine are the standard, well-studied treatments, while naltrexone has less research and is used more selectively. So the medications differ in mechanism, in their effect on the newborn, in how they are started, and in the evidence supporting them in pregnancy, which is why the choice is made individually with specialists.
What is neonatal abstinence syndrome?
Neonatal abstinence syndrome (NAS), also called neonatal opioid withdrawal syndrome, is a condition in which a newborn baby experiences withdrawal after being exposed to opioids in the womb, because the baby has become physically dependent on the opioid and then, after birth, is no longer receiving it. It can occur when the mother has taken opioids during pregnancy, including opioid-based treatments for opioid use disorder such as methadone and buprenorphine. Symptoms in the newborn can include irritability, high-pitched crying, trembling, poor feeding, sleep problems, sweating, and other signs, appearing in the days after birth. Importantly, neonatal abstinence syndrome is a recognised, anticipated, and treatable condition: when a mother is on opioid-based treatment, the medical team expects the possibility and monitors and manages the baby accordingly, with supportive care and, if needed, treatment, and babies generally recover well. The occurrence of NAS does not outweigh the substantial benefits of treating the mother’s opioid use disorder, which greatly improves outcomes for both mother and baby compared with untreated addiction. Relevant to naltrexone (Vivitrol), because it is an opioid blocker rather than an opioid, it does not expose the baby to an opioid and does not cause neonatal abstinence syndrome, which is sometimes considered a potential advantage. However, this is one of many factors weighed in the individualised decision about treatment in pregnancy, which should be made with specialists.
Why must opioid or alcohol addiction be treated during pregnancy?
Opioid or alcohol addiction must be treated during pregnancy because untreated addiction poses serious, well-established dangers to both mother and baby, which are generally far greater than the considerations around any particular treatment medication. Untreated opioid use disorder in pregnancy involves the risks of continued illicit drug use, which can be unpredictable and dangerous, the serious risk of overdose (a leading cause of death), the harms of an unstable, chaotic situation, and risks to the pregnancy and baby, and cycles of intoxication and withdrawal can themselves be harmful. Untreated alcohol use disorder in pregnancy carries the serious risk of harm to the developing baby from alcohol, among other dangers. Treating the addiction, by contrast, stabilises the mother, reduces or stops illicit or harmful substance use, lowers the risk of overdose, and enables engagement with prenatal care and support, greatly improving outcomes for both mother and baby. This is why established treatments like methadone and buprenorphine (for opioid use disorder) are recommended in pregnancy: the benefits of treatment strongly outweigh the manageable considerations such as neonatal abstinence syndrome. The priority, therefore, is that the addiction is treated, and the question of which specific medication (including whether naltrexone is appropriate) is decided individually with specialists. If you are pregnant and have a substance use disorder, seeking specialist care is essential, both for your own health and your baby’s, and effective, supportive treatment is available.
What should you do if you’re pregnant and on Vivitrol or another addiction medication?
If you are pregnant (or planning pregnancy) and are on Vivitrol (naltrexone) or another addiction medication such as methadone or buprenorphine, the most important thing is to speak with your healthcare team as soon as possible, and not to stop, start, or change your medication on your own. Stopping treatment suddenly can be dangerous, both because of the risk of returning to substance use (with the associated dangers, including overdose) and, for some medications, because of withdrawal, so any changes must be made with medical guidance. You should be cared for by a team that ideally includes both an obstetrician (or maternal-fetal medicine specialist) and an addiction specialist, who can review your situation, discuss the risks and benefits of your current and alternative treatments in pregnancy, and make an individualised plan with you through shared decision-making. This is the appropriate way to decide whether to continue your current medication or adjust your treatment. It is important to know that the priority is keeping both you and your baby safe by ensuring your addiction is well treated, and that effective, supportive options exist. You should also engage with prenatal care and any additional support available. So the key steps are: do not change your medication on your own, seek or continue specialist care combining obstetric and addiction expertise, and make treatment decisions together with your doctors. If you are pregnant with a substance use disorder and not yet in treatment, seek specialist care promptly, as treatment protects both you and your baby.
Sources
American College of Obstetricians and Gynecologists (ACOG). Opioid Use and Opioid Use Disorder in Pregnancy. https://www.acog.org/
Substance Abuse and Mental Health Services Administration (SAMHSA). Treating Substance Use Disorder in Pregnancy. https://www.samhsa.gov/
National Institute on Drug Abuse (NIDA). Medications to Treat Opioid Use Disorder. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction
National Library of Medicine (MedlinePlus). Naltrexone Injection. https://medlineplus.gov/druginfo/meds/a609007.html
Centers for Disease Control and Prevention (CDC). Substance Use During Pregnancy. https://www.cdc.gov/
World Health Organization (WHO). Guidelines for Substance Use in Pregnancy. https://www.who.int/
Vivitrol and pregnancy — key entities and related terms
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