Transformation of aid strategy.
Previously, it was believed that there was only one way: to stop drinking immediately for a long time or forever.
The latest treatment methods allow you to choose. Over the course of many years of experience working with patients, psychiatrists, narcologists and medical psychotherapists have come to the conclusion that most patients are not ready to immediately stop drinking and completely give up alcohol once and for all. During the psychotherapeutic work after withdrawal from binge drinking, the patient was offered a free choice in his future relationship with alcohol:
1. Quit drinking completely (immediately or permanently).
2. Drink as before (trying to use your own willpower).
3. Reduce consumption to moderate levels (prevent binge drinking). Those. take safe doses of alcohol.
In many cases, for a number of reasons (the need to drink alcohol due to the nature of work, characteristics of national culture, doing business, etc.), patients preferred the 3rd option. The latest treatment methods allow you to make such a choice and come to harmony with yourself.
Side effects of the drug Vivitrol price of the procedure
Vivitrol instructions contain a wide list of possible adverse reactions, however, it is believed that these reactions will not lead to a serious deterioration in well-being and quickly cease to bother patients. Most often, side effects appear during the first administration. This may be nausea, vomiting, sleep disturbances, headaches, nervousness, rash, muscle pain, lethargy, local reactions such as compaction, swelling, soreness.
You can buy Vivitrol in many pharmacies, and the approximate price of Vivitrol is 15,000 rubles. However, it should be remembered that Vivitrol price instructions do not recommend self-administration of the drug; the procedure should be performed exclusively by a narcologist.
The cost of coding with VIVITROL at the Alco-Center clinic is 20,000 rubles.
The essence of the method
The method of reducing alcohol consumption is a combination of psychotherapy using medications that block the pleasure center and make drinking pointless. Only such a combination of psychotherapy and pharmacotherapy can lead to a positive result in reducing the harm of alcohol consumption and prevent the further development of binge drinking.
Psychotherapy.
Any person who abuses alcohol has his own characteristics, his own personal story about how he started drinking, and his story of struggling with this illness is also “his own”, special, it cannot be standard. And the forms of use are also different: one drinks heavily for several days or weeks, subsequently without experiencing any craving for alcohol, even to the point of disgust for some time, the second uses it every day and does not even get hungover, the third goes into a “tailspin” for the weekend and “nurturing” by Monday. But in their hearts they all dream of getting rid of the troubles associated with drinking and getting rid of the hangover forever...
It has been scientifically proven that it is impossible to force a person to make any decision against his will; he will still strive for his own, his own choice. Every person at any moment of his life, consciously or unconsciously, makes only his own free choice (when a cat jumps out in front of a car, we unconsciously press the brake pedal or consciously take risks by crossing the road in the wrong place). Psychotherapists help the patient make an informed, free decision regarding alcohol. The final goal is determined: To what level should consumption be reduced? How soon? What is the ideal consumption plan? The treatment plan is determined by a doctor - psychotherapist - narcologist. Alcohol addiction is a condition that usually develops over many years, so it is natural that the treatment plan lasts several months . Movement towards the goal occurs in small steps, relying on the strengths of the patient’s personality. Work is carried out with the patient’s relatives, since their faith in the positive outcome of treatment is very important. The patient and his relatives need to be regularly monitored by a doctor and report any changes that occur. Compassion, understanding and respect for the patient are the main postulates of the Center’s psychotherapists, since excessive alcohol consumption is not so much pleasure as ultimately suffering, leading to depression and stress.
Pharmacotherapy (use of drugs)
Treatment begins from the very first meeting - with withdrawal from binge drinking, and then Vivitrol or Selincro is used.
With alcohol abuse, the Pleasure Center overreacts to stimulation by alcohol, the ability to self-control decreases and the “Stop System” (Decision Making Center) is overcome and the person wants to drink more and more, and this desire crowds out all others. This is called “SECONDARY CREDIT FOR ALCOHOL” or the priming effect (“after a couple of drinks I can’t stop...”). Treatment, i.e. the use of Vivitrol or Selincro, aimed at reducing alcohol consumption, has an effect on the Pleasure Center and reduces the “SECONDARY CRAVING FOR ALCOHOL”, reduces the desire to drink after taking small doses of alcohol, thereby bringing the motivation system into the necessary balance, preventing the occurrence of binge drinking (“drank a little , but I don’t want to continue”).
Vivitrol 380 mg No. 1 bottle complete with solvent, syringe and needles
Content
Indications Children and elderly patients Contraindications With caution Use during pregnancy and breastfeeding Side effects Interaction Method of administration and dosage Overdose Precautionary measures Storage conditions Expiration date
Indications
- treatment of alcohol dependence in patients who are able to abstain from drinking alcohol before starting treatment (patients should not actively consume alcohol at the beginning of treatment with Vivitrol);
- preventing relapse of opioid dependence after opioid detoxification (patients should not take opioids when starting treatment with the drug).
Treatment with Vivitrol should be part of an appropriate alcohol dependence program that includes psychosocial support.
Children and elderly patients
There are no data on the safety and effectiveness of the drug in children. Clinical trials of Vivitrol did not include enough patients over 65 years of age to compare the effect of treatment in older patients with younger patients.
Contraindications
- patients taking narcotic analgesics;
- when taking opioids during treatment with the drug;
- patients in a state of acute opioid withdrawal (opioid withdrawal syndrome);
- patients who fail a naloxone challenge or test positive for opioids in their urine;
- patients with hypersensitivity to the active substance of the drug or any of its fillers and solvent components;
- with severe liver dysfunction (including acute hepatitis and liver failure);
- during pregnancy and lactation;
- children under 18 years of age.
Carefully
Use for liver failure: patients with mild or moderately severe liver dysfunction (Child-Pugh classes A and B) do not require dose adjustment. The pharmacokinetics of Vivitrol have not been studied in patients with severe liver dysfunction. In such patients, Vivitrol, like all other IM injections, should be administered with caution due to the risks associated with IM injection (for example, in the presence of thrombocytopenia and coagulation disorders).
Use in renal failure: patients with mild renal failure (creatinine clearance 50–80 ml/min) do not require dose adjustment. The pharmacokinetics of Vivitrol have not been studied in patients with moderate to severe renal failure. Due to the fact that naltrexone and its primary metabolite are excreted primarily in the urine, it is recommended that Vivitrol be administered with caution to patients with moderate or severe renal impairment.
Use during pregnancy and breastfeeding
The effects of Vivitrol on pregnant women have not been studied. Vivitrol should be prescribed during pregnancy only if the potential benefit from its use outweighs the potential risk to the fetus.
Following oral administration of naltrexone, excretion of naltrexone and 6-β-naltrexol into breast milk has been noted. Due to the potential for carcinogenicity and the potential for serious adverse effects in nursing infants, a decision should be made to discontinue Vivitrol therapy during breastfeeding or discontinue breastfeeding during treatment, depending on the importance of therapy to the mother.
Side effects
Side effects in patients with alcohol dependence
Occurred in clinical trials in more than 5% of cases (frequent), the severity of these side effects was characterized as mild to moderate.
- From the gastrointestinal tract: nausea, vomiting, diarrhea, frequent urge to defecate, gastrointestinal upset, frequent loose stools, abdominal pain, stomach discomfort, dry mouth, anorexia, decreased appetite, impaired appetite.
- From the respiratory system: upper respiratory tract infections, laryngitis, sinusitis, pharyngitis (including streptococcal), nasopharyngitis.
- General disorders and reactions at the injection site: pain, soreness, induration, swelling, itching, hemorrhage, asthenia, lethargy, lethargy.
- Musculoskeletal system: arthritis, joint pain, joint stiffness, back pain, limb pain, muscle spasm, muscle twitching, muscle stiffness.
- From the skin and subcutaneous tissues: rash, papular rashes, prickly heat.
- From the nervous system: headache, migraine, dizziness, fainting, drowsiness, anxiety, sedation.
Side effects in patients with opioid dependence
They were basically the same as in patients with alcohol dependence.
The following are side effects in patients with opioid dependence that occurred in clinical trials in more than 2% of cases (common), the severity of these side effects was characterized as mild to moderate.
- Laboratory indicators: increased activity of ALT, AST and GGT.
- From the respiratory system: nasopharyngitis, influenza.
- From the nervous system: insomnia, headache.
- From the cardiovascular system: increased blood pressure.
- General disorders and reactions at the injection site: pain.
- From the gastrointestinal tract: toothache.
Side effects identified during pre-registration studies of the drug
- From the gastrointestinal tract: taste perversion, increased appetite, reflux esophagitis, constipation, flatulence, hemorrhoids, colitis, gastrointestinal bleeding, paralytic ileus, pararectal abscess, gastroenteritis, tooth abscess, abdominal discomfort, acute pancreatitis.
- General disorders and reactions at the injection site: fever, lethargy, chest pain, chest tightness, weight gain or loss, trembling, chills, facial swelling.
- Mental disorders: irritability, sleep disturbance, alcohol withdrawal syndrome, agitation, euphoria, delirium.
- From the nervous system: impaired attention, migraine, decreased mental activity, convulsions, ischemic stroke, cerebral artery aneurysms, paresthesia.
- From the senses: blurred vision, conjunctivitis.
- From the musculoskeletal system: pain in the limbs, muscle spasms, stiffness in the joints, myalgia.
- From the skin and subcutaneous tissues: increased sweating, incl. at night, itching.
- From the respiratory system: sore throat, shortness of breath, nasal congestion, obstructive bronchitis, bronchitis, pneumonia, laryngitis, sinusitis, upper respiratory tract infections.
- Metabolic: heat stroke, dehydration, hypercholesterolemia.
- From the cardiovascular system: hot flashes, deep vein thrombosis, pulmonary thrombosis, palpitations, atrial fibrillation, myocardial infarction, angina pectoris, unstable angina, chronic heart failure, atherosclerosis of the coronary arteries.
- From the blood and lymphatic system: lymphadenopathy, incl. inflammation of the cervical lymph nodes, increased levels of leukocytes in the blood.
- From the immune system: seasonal allergies, hypersensitivity reactions, incl. angioedema and urticaria, progression of HIV infection in HIV-infected patients.
- From the genitourinary system: spontaneous abortion, decreased libido, urinary tract infections.
- From the hepatobiliary system: cholelithiasis, increased activity of ALT and AST, acute cholecystitis.
Interaction
The interaction of Vivitrol with other drugs has not been studied.
Naltrexone is an antagonist of opioid-containing drugs (such as cough and cold medications, antidiarrheals and opioid analgesics).
Since naltrexone is not a substrate of cytochrome enzymes, inducers or inhibitors of these enzymes are unlikely to affect the clearance of Vivitrol. No studies have been conducted to assess the clinical significance of the effect of other drugs on the metabolism of Vivitrol, so caution should be exercised and the possible risks and potential benefits should be assessed when prescribing Vivitrol together with other drugs.
The safety indicators for using Vivitrol with and without antidepressants are the same.
Directions for use and doses
Intramuscularly, into the gluteal muscle, alternating buttocks.
Vivitrol should be administered by qualified healthcare professionals only using the ingredients provided in the package. Packaging components must not be replaced.
The recommended dose of Vivitrol is 380 mg IM once every 4 weeks or once a month.
Vivitrol cannot be administered intravenously!
If the patient misses the next dose, the next injection should be given as quickly as possible. Oral naltrexone is not required before using Vivitrol.
Resumption of treatment after a break. There are no data on resumption of treatment after a break.
Transferring patients with alcohol dependence from oral naltrexone to Vivitrol. There is no systematic data on the transfer of patients from oral naltrexone to Vivitrol.
Overdose
Data on overdose are very limited. Single doses of 784 mg were administered to 5 healthy volunteers. They reported no serious side effects.
Symptoms
: The most common side effects were injection site reactions, nausea, abdominal pain, drowsiness and dizziness. There was no significant increase in liver enzyme activity.
Treatment
: maintenance therapy.
Precautionary measures
To avoid the development of acute withdrawal syndrome in patients with opioid dependence and to prevent exacerbation of existing ones, patients should stop taking opioids at least 7-10 days before starting treatment with Vivitrol.
Since the absence of opioids in the urine is often insufficient to confirm the absence of opioids in the body, if there is a risk of withdrawal syndrome, a naloxone challenge test should be performed before using Vivitrol.
Elimination of blockade of opioid receptors with Vivitrol.
In an emergency situation in patients treated with Vivitrol, regional analgesia or non-narcotic analgesics are the preferred method of pain relief.
If patients require the use of narcotic analgesics for anesthesia or analgesia, such patients should be under long-term medical supervision.
Therapy with narcotic analgesics should be carried out by specially trained personnel (to avoid breathing problems) capable of performing mechanical ventilation in case of complications.
Regardless of the agent chosen to reverse the effects of naltrexone, the patient should be under constant supervision of qualified medical personnel in a specially equipped intensive care unit.
Depression and suicidal behavior.
Patients with alcohol and/or opioid dependence, incl. patients receiving treatment with Vivitrol. Family members and caregivers of patients should be advised to monitor closely for symptoms of depression or suicidal behavior and to immediately report such symptoms to their healthcare provider.
- In patients with alcohol dependence. During controlled clinical trials of Vivitrol, suicidal behavior (suicidal ideation, suicide attempts, completed suicides) was observed infrequently, but occurred more often in the group of patients treated with Vivitrol than in the group of patients receiving placebo (1% vs. 0). In some cases, suicidal thoughts and behavior were recorded in the patient after completion of the study, but were a consequence of depression that developed during treatment with the drug. There were two suicides, in both cases the patients were treated with Vivitrol.
Discontinuation due to depression occurred more frequently in the Vivitrol group (1%) than in the placebo group (0).
In a 24-week placebo-controlled study, depression-related adverse events occurred in 10% of patients treated with Vivitrol 380 mg and in 5% of patients treated with placebo injections.
- In patients with opioid dependence. During safety studies of Vivitrol, suicidal side effects (depressed mood, suicidal ideation, suicide attempts) were reported in 5% of opioid-dependent patients receiving Vivitrol and in 10% of patients receiving oral naltrexone.
In a 24-week placebo-controlled study, no adverse events such as depressed mood or suicidal ideation were observed in either the Vivitrol 380 mg group or the placebo injection group.
Reactions at the injection site.
Vivitrol injections may be accompanied by pain, tenderness, induration, swelling, erythema and itching. However, in some cases reactions at the injection site can be very severe. During clinical trials, one patient developed a lump that continued to enlarge 4 weeks after injection, followed by necrosis that required surgery to remove. During post-marketing surveillance, other cases of injection site reactions including induration, subcutaneous tissue inflammation, hematoma, abscess, sterile abscess and necrosis were observed, some of which required surgical intervention. In some cases, mostly in women, scarring has occurred at the injection site. Vivitrol is intended for injection into the gluteal muscle; accidental subcutaneous injection of the drug may increase the likelihood of serious adverse reactions at the injection site. The injection needle included in the package is designed specifically for administering Vivitrol and should under no circumstances be replaced with any other needle. In some cases, due to your body type, the length of the needle may not be sufficient for an intramuscular injection. Therefore, before giving an injection, the doctor must make sure that the needle is suitable for his patient. If the needle does not fit, another treatment should be prescribed. Patients should be warned about the need to inform their doctor about the occurrence of any reaction at the injection site. If signs of an abscess, inflammation of the subcutaneous tissue, necrosis or significant swelling occur, a decision should be made on the advisability of surgical intervention.
Alcohol withdrawal.
The use of the drug Vivitrol not only does not exclude, but also does not reduce the manifestation of symptoms associated with the withdrawal of alcohol intake.
Retinal artery occlusion.
Occlusion of the retinal artery after injection of another drug containing a copolymer of lactic and glycolic acid was very rare in post-registration studies and occurred in the presence of an abnormal arteriovenous anastomosis. During clinical and post-registration studies of Vivitrol, not a single case of retinal artery obstruction was observed. Vivitrol should be injected only into the gluteal muscle, avoiding entering a blood vessel.
Storage conditions
At 2–8 °C (do not freeze). Storage is allowed at a temperature not exceeding 25 °C for no more than 7 days. Avoid exposure to temperatures above 25 °C.
Keep out of the reach of children.
Best before date
3 years.
Do not use after the expiration date stated on the package.
Myths and facts about esperal stitching
Esperal only affects suggestible people
Fact: The statement is false.
The effect of the administered drug is chemically determined and does not depend on the patient’s “faith” or “fear”. After the procedure, the patient experiences extremely unpleasant symptoms when consuming even a very small amount of alcohol.
Drinking alcohol after getting Esperal is fatal.
Fact: Under certain circumstances the consequences can be extremely severe.
The drug administered to the patient blocks the work of enzymes that break down alcohol. Therefore, toxic substances contained in alcohol easily penetrate into the blood and internal organs.
The body reacts immediately with a variety of unpleasant symptoms. If the patient does not limit himself to the minimum portion, or decides to repeat the “experiment” after some time, the consequences can be very severe.
Therefore, if the patient drinks alcohol after the stitching procedure, it is necessary to immediately consult a doctor. The specialist will introduce an alcohol-neutralizing drug and stop its negative effects.
When sewing in, drugs that are hazardous to health are introduced, so complications are possible even without drinking alcohol.
Fact: not true
Substances contained in alcohol and its breakdown products are hazardous to health. Under normal conditions, the liver and pancreas take the brunt of toxins. They produce enzymes that partially neutralize the effects of alcohol. The drug used for injections for alcoholism acts on these enzymes, and the poisons of alcohol affect the body without “processing”.
There are a number of restrictions when, due to the patient’s health, the doctor does not recommend sewing in Esperal.
In this case, after an examination, medical history and necessary tests, the doctor will recommend other ways to combat alcoholism. Thus, with professional sewing and abstinence from alcohol, complications are extremely rare.
