Request information on VIVITROL

Physician Registration Fax Form

Help people find your practice so they can learn more about alcohol dependence and treatment. Our online Physician Locator will provide the contact information and street address for your practice, as well as link to online driving directions.

If you would like to add your practice to our online Physician Locator, please download the enrollment form below. Fill out the one-page form and fax it back.

Download the Physician Locator registration form.

Note: This form is provided in Adobe^® Reader^® format (PDF). In order to view PDF documents, you must have the free Adobe Reader software installed on your computer. If you do not have the Adobe Reader, download it from the Adobe Web site.

Important Safety Information

Naltrexone has the capacity to cause hepatocellular injury when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with active liver disease must be carefully considered in light of its hepatotoxic effects. The margin of separation between the apparently safe dose of naltrexone and the dose causing hepatic injury appears to be only five-fold or less. VIVITROL does not appear to be a hepatotoxin at the recommended doses. Patients should be warned of the risk of hepatic injury and advised to seek medical attention if they experience symptoms of acute hepatitis. Use of VIVITROL should be discontinued in the event of symptoms and/or signs of acute hepatitis.

VIVITROL is indicated for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL.

Patients should not be actively drinking at the time of initial VIVITROL administration.

Treatment with VIVITROL should be part of a comprehensive management program that includes psychosocial support.