These 5 Medications for Alcohol Use Disorder Can Help You Stop Drinking

Alcohol use disorder (AUD) is a condition where a person has difficulty managing their alcohol use. There are several ways to treat AUD, including therapy, support groups, and medications. But what are the specific medications used to treat AUD, and what’s the difference between them?

Here, we’ll cover five of the most effective types of medication for AUD to help you stop drinking.

Quiz: Should you cut back on alcohol?

1. Naltrexone

Naltrexone is a first-choice option for moderate-to-severe AUD, according to the American Psychiatric Association (APA). It may help people who want to stop drinking alcohol completely (abstinence) as well as those who want help drinking less (moderation). 

How it works

Naltrexone is an opioid blocker. When you drink alcohol, your body releases chemicals that make you feel good. These include natural opioids and dopamine. These chemicals play a role in substance misuse and dependence.

Naltrexone prevents these chemicals from working in the body. This helps reduce the rewarding effects of alcohol as well as cravings for it.

Dosage

Naltrexone comes as an oral tablet as well as a long-acting injection under the brand name Vivitrol.

The usual starting dosage of naltrexone tablets is 50 mg once a day.

The typical Vivtrol dosage is 380 mg injected into the muscle once every 4 weeks (1 month). But you can’t inject Vivtrol on your own — you’ll need to receive it in a healthcare setting. Still, this option is helpful for those who have trouble remembering to take a daily tablet.

There isn’t a set amount of time you’ll need to take naltrexone. It’s a long-term treatment for some people, and a short-term treatment for others. Your prescriber will work with you to determine if and when you’re able to stop taking naltrexone.

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Side effects

Common naltrexone side effects include:

• Nausea

• Headache

• Injection site reactions (Vivitrol only)

• Dizziness

• Anxiety

• Joint and muscle pain

These side effects often improve as your body adjusts to naltrexone. But let your prescriber know if they worsen or become bothersome.

More serious Naltrexone side effects include liver damage and thoughts of self-harm or suicide. It can also lead to opioid withdrawal or make you more sensitive to opioids in certain situations. Naltrexone isn’t recommended for those living with liver problems or taking opioids regularly.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line. 

2. Acamprosate

Like naltrexone, acamprosate is considered a first-choice option for AUD. It’s often prescribed for people living with liver problems or taking opioids who can’t take naltrexone. But unlike naltrexone, acamprosate is typically only started after you stop drinking alcohol. 

How it works

We don’t know exactly how acamprosate works. But experts believe it helps reduce alcohol cravings by lowering the levels of a chemical called glutamate.

People living with AUD have higher levels of glutamate in the brain. And high glutamate levels can increase alcohol cravings as well as worsen withdrawal symptoms when you stop drinking. Acamprosate may help correct these issues by lowering glutamate levels to reduce cravings as well as alcohol withdrawal symptoms.

Dosage

The typical acamprosate dosage is 2 tablets (333 mg each) by mouth 3 times a day. Taking it with meals can reduce nausea as well as help you remember your doses.

As mentioned, it’s best to start acamprosate after you’ve stopped drinking and any withdrawal symptoms have resolved. But if you relapse (return to drinking alcohol), you can keep taking it in most cases. Just be sure to let your prescriber know if this occurs.

You may need a lower acamprosate dosage if you’re living with kidney problems. Your prescriber will let you know if this applies to you.

Side effects

Common acamprosate side effects include:

• Diarrhea

• Trouble sleeping

• Anxiety

• Fatigue

Similar to naltrexone, these side effects often resolve on their own as your body adjusts to the medication.

Acamprosate may cause depression as well as suicidal thoughts or behavior in some people. Seek medical care right away if you notice any mood or behavior changes while taking it.

3. Disulfiram

Disulfiram is the oldest FDA-approved medication for AUD. You may be familiar with the brand-name, Antabuse, though it’s no longer available.

While naltrexone or acamprosate are considered the preferred medications for AUD, disulfiram may be a good option for people who are unable to take these first-choice options.

How it works

Disulfiram works by preventing your liver from breaking down alcohol after you consume it. If you drink alcohol while taking disulfiram, this leads to a build up of acetaldehyde (a chemical in alcohol) in the body. High acetaldehyde levels cause what’s known as a “disulfiram-alcohol reaction.” This causes nausea, sweating, and heart palpitations. It can also cause facial flushing and dizziness. The idea is that this unpleasant reaction will discourage you from drinking alcohol.

This unpleasant reaction with alcohol can lead people to skip doses or stop taking disulfiram. So it works best if you take it under supervision. This could include a friend or family member or as part of an AUD treatment program.

Good to know: Some people have a genetic variation that causes the same reaction as disulfiram when they drink alcohol. It’s an inherited trait that’s found in about 8% of the world’s population, but it’s more common in people of East Asian descent.

Dosage

The typical disulfiram dosage for AUD starts at 500 mg by mouth once daily for 1 to 2 weeks. After that, your prescriber may decrease your dosage to 125 mg or 250 mg daily based on your response.

Disulfiram starts working within a few hours. So it’s best to wait at least 12 hours after consuming alcohol to start taking it.

Side effects

Most of the common disulfiram side effects improve or go away after about 2 weeks. They may include:

• Headache

• Fatigue

• Sexual problems, such as erectile dysfunction

• Skin irritation

• An unusual aftertaste

Disulfiram can also cause more serious side effects. These include liver damage and nerve problems. Psychotic symptoms, such as seeing or hearing things that aren’t there, can also occur.

Keep in mind that the disulfiram-alcohol reaction can occur with any substances that contain alcohol. This can include things such as over-the-counter cough and cold products, liquid vitamins, and flavoring extracts. Be sure to check labels carefully while taking disulfiram to avoid an unwanted issue.

4. Topiramate

Topiramate (Topamax) is medication that’s FDA approved to treat seizures and prevent migraines. But it’s often used off-label for other medical conditions, including AUD. In fact, the APA recommends topiramate as an option for people if naltrexone or acamprosate aren’t effective.

How it works

It isn’t clear exactly how topiramate works for AUD. But it seems to reduce glutamate levels in a way that’s similar to acamprosate. This can help reduce alcohol cravings as well as withdrawal symptoms. Topiramate may also help reverse brain changes caused by chronic alcohol use. 

Dosage

Since topiramate isn’t FDA approved for AUD, there isn’t a specific dosage that’s recommended.

In most cases, you’ll start with a low dose of topiramate and slowly increase it over time. This helps reduce side effects as your body adjusts to the medication.

Most studies used topiramate dosages of at least 250 mg per day. But low-dose topiramate (up to 75 mg per day) may also be effective for AUD, especially when combined with therapy. Your prescriber will determine the right topiramate dosage for you based on your personal history and goals.

Side effects

Common topiramate side effects include:

• Pins-and-needles sensation in the hands and feet

• Fatigue

• Dizziness

• Weight loss

• Anxiety

• Trouble with focus or memory

• Taste changes

More serious topiramate side effects include:

• Severe vision problems

• Reduced sweating that can lead to hyperthermia (overheating)

• Metabolic acidosis

• Suicidal thoughts or behaviours

• Serious skin reactions

As mentioned, starting with a low dose of topiramate and increasing it slowly can help minimize side effects. Higher topiramate dosages are also more likely to cause side effects overall.

Keep in mind that it can be dangerous to stop taking topiramate suddenly. So if side effects are bothersome, talk to your prescriber about reducing your dosage. They can also provide directions for stopping topiramate safely if needed.

5. Gabapentin

Gabapentin (Neurontin) is FDA approved to treat epilepsy and shingles-related nerve pain (postherpetic neuralgia). Like topiramate, it’s also prescribed off-label for AUD, but it isn’t a first-choice option.

How it works

Gabapentin seems to help balance glutamate levels to reduce alcohol cravings. It also helps reduce alcohol withdrawal symptoms and may help reduce relapse in some cases. This may be due to gabapentin’s ability to improve sleep quality, along with its other effects on the brain. 

Dosage

As with topiramate, there isn’t a set gabapentin dosage for AUD, since it isn’t FDA approved for this use.

Gabapentin dosages used in clinical studies range from 300 mg to 1800 mg per day. It’s typically taken once daily at bedtime, but it can also be divided into 2 or 3 smaller doses throughout the day. In most cases, you’ll start with a low dose and increase it over time to help reduce side effects. Your prescriber will help determine the right gabapentin dosage for your needs.

Side effects

Common gabapentin side effects include:

• Drowsiness

• Dizziness

• Fluid retention

• Balance and coordination problems

• Brain fog

These side effects may improve once your body gets used to the medication.

More serious gabapentin side effects include:

• Potential for dependence and misuse

• Suicidal thoughts or behaviors

• Trouble breathing when combined with medications such as opioids and benzodiazepines

• Seizures if stopped abruptly

Since gabapentin can lead to dependence and misuse on its own, there’s some concern about the risks of using it for AUD. That’s because combining gabapentin and alcohol can raise the risk of serious side effects, including death. Your prescriber can help determine if gabapentin is a safe treatment option for you based on your personal history.

Which medication for AUD is the most effective?

It depends. Most research shows that naltrexone and acamprosate are the best first-choice options for most people. They seem to be similarly effective at treating AUD. But certain factors may affect which one is the right fit for you.

For example, naltrexone may be a better option if you’re also trying to quit smoking. It’s also more convenient for many people, since it only requires once-daily or once-monthly doses. Acamprosate may be better if you’re also having trouble sleeping.

You should avoid naltrexone if you’re living with severe liver problems. And you should avoid acamprosate if you’re living with severe kidney problems.

Disulfiram and topiramate are typically only prescribed if naltrexone and/or acamprosate aren’t effective or tolerated. But disulfiram may be more effective than acamprosate or naltrexone when given under supervision in a clinical setting.

Gabapentin, on the other hand, is often reserved for acute withdrawal symptoms, rather than ongoing sobriety.

Your prescriber can review the risks and benefits of these medications to help you find the best fit for your needs.

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Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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