How should I taper off Vivitrol / ReVia (naltrexone)?

For oral naltrexone, most patients can stop without taper. For depot, the long half-life provides a natural taper. Plan for return of cravings. Naltrexone is not dependence-forming; the main risk on discontinuation is loss of the medication-supported buffer against the underlying disorder, not pharmacological withdrawal.

How long does Vivitrol / ReVia withdrawal last?

Vivitrol / ReVia withdrawal typically begins Days (oral) or weeks (depot wear-off), peaks around 1-2 weeks, and resolves within Usually 2-4 weeks. Rare for the medication itself; the underlying condition is the main long-term consideration

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Vivitrol / ReVia Tapering Guide

naltrexone

OtherFDA 1984

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Overview

Naltrexone is an opioid antagonist used for alcohol use disorder and opioid use disorder relapse prevention. Low-dose naltrexone (4.5mg, LDN) is used off-label for chronic pain, fibromyalgia, and inflammatory conditions — different mechanism, different evidence base.

Common Doses

50mg tablets (oral); 380mg IM monthly (Vivitrol); 4.5mg compounded (low-dose naltrexone, off-label)

Formulations

Tablets: 50mg; IM (Vivitrol): 380mg/month; Compounded LDN: 1.5-4.5mg (off-label)

Pregnancy

Category C

Mechanism of Action

Competitive antagonist at mu, kappa, and delta opioid receptors. At low doses, paradoxical effects may involve transient receptor blockade and endogenous opioid upregulation.

Taper Notes

For oral naltrexone, most patients can stop without taper. For depot, the long half-life provides a natural taper. Plan for return of cravings.

Maudsley Deprescribing Guidance

Naltrexone is not dependence-forming; the main risk on discontinuation is loss of the medication-supported buffer against the underlying disorder, not pharmacological withdrawal.

Withdrawal Timeline

⏱Onset

Days (oral) or weeks (depot wear-off)

📈Peak Severity

1-2 weeks

📉Resolution

Usually 2-4 weeks

⚠️Protracted Risk

Rare for the medication itself; the underlying condition is the main long-term consideration

Common Withdrawal Symptoms

mild — naltrexone itself does not produce dependenceunderlying alcohol/opioid cravings can return without the medication-supported buffer

Interactions & Safety

Drug Interactions

All opioids — naltrexone blocks effects; if opioid is needed for pain, will require much higher doses with careful monitoring
Yohimbine — additive effects

Contraindications

Current opioid use or dependence (will precipitate withdrawal)
Acute opioid withdrawal
Severe hepatic impairment

Toxicity

Hepatotoxicity (dose-dependent — uncommon at standard doses), nausea, headache, dizziness, anxiety, insomnia, depression. Will precipitate severe withdrawal in opioid-dependent patients.

Sources & References

Vivitrol / ReVia (naltrexone) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.

Encyclopedic & chemical databases

Neutral, high-authority entity references.

Regulatory sources

Official prescribing information and safety notices.

FDA prescribing information — Vivitrol / ReVia (naltrexone)

Peer-reviewed research

Primary literature cited in this taper guide.

Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)

Clinical guidelines

Evidence-based deprescribing and prescribing standards.

Deprescribing-specific resources

Clinician-facing references on tapering protocols.

SAMHSA — Medication-Assisted Treatment — Federal guidance on MAT for opioid use disorder
Deprescribing.org — opioid algorithm — Evidence-based opioid deprescribing algorithm
CDC Clinical Practice Guideline for Prescribing Opioids — 2022 CDC guideline on opioid prescribing for chronic pain

Patient-advocacy & lived-experience

Long-running communities documenting withdrawal experience.

SAMHSA National Helpline — 24/7 confidential support for substance use and mental health
Mad in America — opioid coverage — Independent journalism on opioid tapering and recovery
Inner Compass Initiative — Withdrawal Project — Peer-led resources for medication withdrawal
RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects

TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.

Pharmacokinetics

ADME Profile

Metabolism

Hepatic via dihydrodiol dehydrogenase.

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