What is the anti-alcohol injection?
The anti-alcohol injection is the everyday name for a medicine used in the treatment of alcohol dependence: extended-release naltrexone. It is given as a deep intramuscular injection once every 4 weeks. The active substance is naltrexone, and a single injection contains a dose of 380 mg. The product is sold under the trade name Vivitrol.
The medicine takes the form of very small beads, known as microspheres, from which naltrexone is released slowly and steadily across the whole month. As a result, the patient does not have to remember a tablet every day, because a single dose keeps the medicine working consistently between visits.
What the anti-alcohol injection is for
The injection supports someone with an addiction in cutting down their drinking and staying abstinent. It is not a stand-alone cure. As part of addiction pharmacotherapy, it works best alongside therapy and psychological support. The medicine itself reduces alcohol craving, but it is the overall treatment plan that determines how lasting the results are.
How does naltrexone given by injection work?
Naltrexone is an opioid receptor antagonist: it blocks the receptors in the brain through which alcohol triggers feelings of pleasure and reward. When those receptors are occupied by the medicine, drinking alcohol produces a weaker effect, and over time the alcohol craving itself, the compulsion to drink, also fades.
The anti-alcohol injection is not an implant
Naltrexone does not cause a violent reaction after alcohol. There is no vomiting, no racing heart and no shortness of breath after the injection. Those symptoms are caused by disulfiram in the alcohol implant. The mechanism is the opposite: instead of discouraging drinking through fear of feeling unwell, naltrexone dampens the pleasure that alcohol gives. Drinking stops bringing the relief it once did, so it becomes easier to give up.
Naltrexone is not psychoactive and is not addictive. During abstinence it does not affect mood or the way a person thinks.
How long a single dose works
The medicine stays in the muscle and is released from the microspheres over about 4 weeks. The naltrexone level in the blood has two peaks: the first around 2 hours after the injection, the second after 2 to 3 days. From roughly day 14 it falls slowly, though measurable levels remain for longer than a month. The manufacturer notes that the block on opioid receptors weakens towards the end of the cycle and eventually disappears completely. This is why the next dose is planned every 4 weeks, and no less often.
Anti-alcohol injection versus the Esperal implant: how do they differ?
Online, the anti-alcohol injection is often confused with the implant, because both methods are associated with a procedure and with treating alcoholism. In fact they are two different medicines with opposite mechanisms of action.
- The injection (naltrexone) blocks opioid receptors and reduces alcohol craving; it produces no reaction if the patient drinks alcohol. It is given intramuscularly every 4 weeks.
- The implant (Esperal, disulfiram) works by aversion: after alcohol is consumed it produces strong, unpleasant symptoms meant to deter the person from drinking. It is placed under the skin during a minor procedure.
The implant discourages drinking through fear of feeling unwell, while the injection takes away the pleasure on which the habit rests. Neither method is better than the other by default; the choice is made by the doctor together with the patient, based on drinking history, co-existing conditions and expectations.
Injection or naltrexone tablets: which to choose?
Naltrexone comes in two forms: as tablets taken every day, and as an extended-release injection given once every 4 weeks. The active substance is the same; what differs is the way it is given and how often.
Consistency: the injection's main advantage over tablets
With tablets, the effect depends on taking them every day without fail, and that is hardest precisely on the days when motivation dips and temptation is strongest. The injection takes that daily decision away from the patient: the medicine works without interruption for a whole month, regardless of how someone feels at any given moment.
Tablets have their own advantages: they are registered in Poland and easier to obtain, whereas the injection has to be brought in through targeted import. Both forms serve the same purpose: reducing alcohol craving and supporting abstinence. Which one to choose is decided at the qualifying appointment.
Who is the anti-alcohol injection for, and who cannot receive it?
The injection is considered for adults with alcohol dependence who want to cut down their drinking or stay abstinent and are ready to combine medication with therapy. It is particularly helpful for people who find it hard to remember a tablet every day.
When the anti-alcohol injection cannot be given
Naltrexone blocks opioid receptors, so it must not be given to anyone taking opioids (including painkillers, cough medicines or substitution treatment) or to anyone in acute withdrawal. It is also contraindicated in acute hepatitis or severe liver failure, in pregnancy, and in the case of hypersensitivity to the medicine.
If the patient is still drinking or in the middle of withdrawal, treatment begins with preparation, for example alcohol detox. Whether the injection is safe in a given situation is decided by the doctor during qualification, which is why treatment does not start straight away.
What does qualification for the anti-alcohol injection involve?
The injection is preceded by a qualifying appointment with a doctor. During it, the doctor checks whether treatment with naltrexone is safe and appropriate for the patient. They take a detailed history, asking about the patient's drinking, previous treatment, the most recent alcohol intake, medicines being taken (especially painkillers and opioids), co-existing conditions, and the goal and motivation for treatment.
Mental state assessment and examination before the injection
The doctor also assesses the patient's mental state: mood, any suicidal thoughts and the risk of relapse. They carry out a physical examination, looking at the planned injection site and checking for signs of liver disease.
Which tests are needed before the injection
Laboratory tests are done before the injection is given. These are usually a full blood count, liver function tests, and tests for hepatitis B and C and for HIV. Women of childbearing age have a pregnancy test, and if opioid use is suspected, a urine test as well. The doctor tailors the exact range of tests to the patient's situation.
Is the anti-alcohol injection available in Poland?
Extended-release naltrexone in injection form (Vivitrol) is not authorised for sale in Poland or in the European Union. It is registered in the United States, among other countries. It can, however, be brought in legally for a specific patient through the targeted import procedure set out in the Pharmaceutical Law.
Targeted import step by step
- The doctor issues a request for the medicine electronically, through the government Targeted Import Handling System (SOID).
- The request is confirmed by the regional or national consultant for the relevant field of medicine, who has 7 days to do so.
- The application goes to the Ministry of Health, which usually reviews it within 21 days.
- Once approval is granted, the pharmacy orders the medicine through a wholesaler, which brings it in from abroad.
The whole procedure takes time, which is why the injection is not given on the day of the first appointment. The medicine has to be arranged between qualification and administration. A separate application for reimbursement of the imported medicine can also be submitted to the Minister of Health; it is considered on a case-by-case basis. In 2022, however, the Transparency Council of the Agency for Health Technology Assessment and Tariff System (AOTMiT) found the granting of such approvals unjustified.
What does having the anti-alcohol injection involve?
The injection is given only by medical staff, in the clinic. Immediately beforehand, the doctor checks safety once more: making sure the patient is not taking opioids, has no withdrawal symptoms, is not pregnant, and is not planning any procedure requiring strong painkillers in the near future.
Preparing the medicine for injection
The medicine is kept refrigerated, at 2-8 °C, and is taken out about 45 minutes before administration so that it warms to room temperature. The suspension is prepared immediately before the injection: the tiny beads of medicine (microspheres) are mixed with the diluent from the kit until a uniform, milky-white suspension forms.
How the injection itself is given
Naltrexone in this form is given only deep into the muscle, in the gluteal muscle, never intravenously or under the skin. The staff match the needle length to the patient's build so that the medicine reaches the muscle, and each subsequent dose is given alternately in the right and left buttock. The injection itself takes only a short time; afterwards the patient stays under observation for a while and then goes home.
What happens after the injection and how often is it repeated?
A single injection works for 4 weeks, so the next dose is planned roughly every month. The clinic keeps a schedule of administrations and medicine orders to avoid any gap between doses.
Advice after the injection
After the injection the patient is given a treatment information card, which they should carry with them. This matters in the event of sudden pain, injury or surgery: any doctor providing care needs to know that the patient is taking naltrexone, because the medicine changes the response to opioid painkillers. Temporary pain or hardening may appear at the injection site.
Check-up visits every 4 weeks
At the monthly visits the doctor assesses how well treatment is working: abstinence or reduced drinking, the intensity of craving, the risk of relapse and engagement in therapy. They also check safety: the injection site, liver status, mood, new medicines and any planned procedures. It is also a moment to talk about progress in therapy.
How long the whole treatment lasts
There is no fixed term, and no document imposes one. The product information specifies neither a minimum nor a maximum length of treatment; it says only that treatment should be part of a programme with psychosocial support. Guidelines approach this cautiously: SAMHSA recommends continuing treatment of alcohol dependence for at least six months to a year, and notes that the optimal length is not known. The VA/DoD guidelines suggest stopping the medicine if no benefit is seen within 3 months. The American Psychiatric Association (APA) counts the length of pharmacotherapy among the questions that research has not yet answered.
In practice, the length of treatment is decided by the doctor together with the patient. At each visit they assess abstinence, the intensity of alcohol craving, the risk of relapse and engagement in therapy, and plan further doses on that basis.
What happens if a dose is delayed
The next injection is given as soon as possible. It is not, however, given sooner than 4 weeks after the previous one, nor in a dose greater than 380 mg.
Is the anti-alcohol injection effective? What the research says
The effectiveness of extended-release naltrexone in alcohol dependence has been assessed in clinical trials. In a randomised trial by Garbutt and colleagues (JAMA, 2005), involving more than 600 patients and lasting 6 months, the group receiving the 380 mg dose showed about 25% fewer heavy drinking days compared with placebo.
A meta-analysis (Murphy, 2022) found that naltrexone in this form reduces the number of drinking days and heavy drinking days compared with placebo, with the effect being clearer over longer treatment.
The authors of the meta-analysis add the caveat that the available evidence covers treatment lasting no more than 6 months, and that the pooled result rests largely on the two largest trials.
Where the anti-alcohol injection fits in a treatment programme
The trial results speak of reduced drinking, not of an instant and permanent cure. In line with the position of the Agency for Health Technology Assessment and Tariff System (AOTMiT), naltrexone is part of a treatment programme with psychosocial support. It reinforces the effects of psychotherapy and other forms of support, and response to treatment varies from one person to another.
Is the anti-alcohol injection safe? Side effects
Naltrexone has been used in addiction treatment for years, and with proper qualification it is regarded as a safe medicine. Like any medicine, however, it can cause side effects. The most common are nausea, headache, fatigue, muscle and joint pain, and reactions at the injection site.
The most important warning concerns opioids
The most serious risk relates to opioids. While the medicine is active and after it wears off, tolerance to opioids is reduced: trying to override the blockade with a large dose of an opioid, or going back to pre-treatment doses, risks respiratory arrest and death. This warning applies to every patient and must not be taken lightly.
The risk is greatest towards the end of the 4-week cycle, after a missed dose and after treatment ends. For at least 30 days after the final injection, no opioid medicines may be taken.
Other situations calling for vigilance
- Liver: jaundice, dark urine or abdominal pain call for urgent contact with a doctor.
- Injection site: pain, swelling, hardening or lumps may appear where the injection was given. Worsening symptoms should be reported; in rare cases the reaction is serious (e.g. tissue necrosis) and needs medical attention.
- Mood: low mood or troubling thoughts are a signal to contact the doctor.
- Shortness of breath after the injection, though rare, should also be reported.
When must the anti-alcohol injection not be given?
The injection is not given if even one of the following situations applies:
- taking opioids, including painkillers, cough and antidiarrhoeal medicines that contain opioids, and substitution treatment;
- acute withdrawal, that is, being in the middle of coming off alcohol;
- acute hepatitis or severe liver failure;
- pregnancy;
- hypersensitivity to naltrexone or to the components of the suspension;
- a procedure planned in the near future that will require opioid pain relief.
Some of these obstacles are temporary: after suitable preparation, such as finishing withdrawal, treatment can begin. That is why qualification is always decided by the doctor on the basis of the history and tests, and not by the patient alone.
How much does the anti-alcohol injection cost?
The cost of the injection cannot be given as a single figure, because it is made up of several elements and some of them depend on the individual patient's situation. The total is influenced by:
- the qualifying consultation and laboratory tests;
- the cost of the medicine itself, brought in from abroad through targeted import;
- giving the injection and care during treatment, repeated every 4 weeks.
Treatment is cyclical, so it is worth planning it as an expense spread over time rather than a one-off. We give an exact quote individually, after qualification, when it is clear which tests and which schedule of injections will be needed. An application for reimbursement of the imported medicine can also be submitted to the Minister of Health, though in 2022 the AOTMiT Transparency Council found the granting of such approvals unjustified.
How do you start treatment with the injection at Nasz Gabinet?
At Nasz Gabinet the anti-alcohol injection is part of alcoholism treatment, not a procedure in isolation. Naltrexone reduces alcohol craving, but a lasting effect depends on therapy alongside it and on the support of loved ones.
Where to begin treatment with the injection
The first step is to get in touch and book a qualifying consultation. During it the doctor will assess whether the injection is appropriate, order the necessary tests and, if there are no contraindications, begin bringing the medicine in through targeted import. If the patient is still drinking, the plan may start with preparation, such as detoxification.
A consultation time can be chosen through the online booking on this page or by phone. We are with you throughout the whole process: from qualification, through the formalities of targeted import, to the monthly injections and ongoing care.
