Acamprosate vs. Disulfiram for Alcohol Use Disorder: 5 Differences You Need to Know

Acamprosate and disulfiram are prescription medications that help treat alcohol use disorder (AUD). But they work in different ways and have different side effects. Knowing about the differences between acamprosate versus disulfiram can help you choose the medication that’s right for you.

1. Acamprosate is a first-choice medication for AUD,disulfiram isn’t

Acamprosate and disulfiram can both help treat AUD. But only acamprosate is considered a first-choice medication. Another medication called naltrexone (Vivitrol) is also considered a first-choice option. If these medications don’t work for you, disulfiram may be a good option.

Is acamprosate or disulfiram more effective?

It depends on the individual and what your goals are. There’s no one-size-fits-all approach to treating AUD. Disulfiram doesn’t lower alcohol cravings or withdrawal symptoms. But acamprosate can have these effects. This can make acamprosate a better option than disulfiram for many people. But while some research shows acamprosate is effective at reducing drinking and alcohol cravings, other studies are mixed.

Research shows that disulfiram can be effective when used under supervision. This includes using disulfiram as part of an AUD treatment program, or even with a family member watching. In fact, some research shows that disulfiram may be more effective than acamprosate when used under supervision. It’s thought that supervision improves medication adherence.

These mixed results highlight that treating AUD is extremely personal. Your preferences and individual situation need to be considered when deciding which medication to use.

Keep in mind: Even if you decide to use medications, the best treatment plan for AUD includes nonpharmacologic therapies such as therapy and support groups.

2. Acamprosate and disulfiram work in different ways

While both acamprosate and disulfiram are approved to treat AUD, they work differently.

Acamprosate

Chronic alcohol use has long-lasting impacts on the brain. Alcohol can change how you think, feel, and behave by altering the usual balance of brain chemicals. These chemicals include gamma-aminobutyric acid (GABA) and glutamate.

Researchers believe acamprosate works by correcting these alcohol-induced changes. Since it’s structurally similar to GABA, it’s able to decrease glutamate levels in the brain. This is a good thing, because increased glutamate levels can reinforce the desire to drink and worsen alcohol withdrawal symptoms. So acamprosate may help lower alcohol cravings and reduce symptoms of alcohol withdrawal.

Disulfiram

Disulfiram prevents alcohol from being broken down (metabolized) in the body. This causes an unpleasant reaction if you drink alcohol while taking disulfiram. For some people, the knowledge that this reaction can occur is enough to make them stop drinking.

3. You shouldn’t drink alcohol while taking disulfiram, but it may be OK to continue acamprosate if you relapse to alcohol

As discussed above, the “disulfiram-alcohol” reaction may cause uncomfortable symptoms. Examples include:

• Flushing in the face or upper chest

• Nausea or vomiting

• Sweating

• Heart palpitations

• Chest pain

• Trouble breathing

Disulfiram begins working within a few hours, but you probably won’t feel differently right away. To prevent the disulfiram-alcohol reaction, doses of disulfiram shouldn’t be taken within 12 hours of ingesting alcohol or any alcohol-containing products (like some cough products).

On the other hand, acamprosate and alcohol don’t have any known interactions. So if you relapse to alcohol while taking acamprosate, it may be OK to continue taking it. But talk to your healthcare provider if you experience a relapse. They’ll want to talk to you about the best way to proceed with treatment for AUD.

4. Acamprosate should be taken 3 times a day, but disulfiram can be taken once a day

When considering what medication to take for AUD, how often you need to take it may be an important factor. Acamprosate comes as a 333 mg oral tablet. The typical dose is 2 tablets 3 times per day. Disulfiram comes as 250 mg and 500 mg tablets. The typical dose is 250 mg to 500 mg once per day.

5. Acamprosate and disulfiram have different side effects

Like all medications, side effects with acamprosate and disulfiram are possible.

Acamprosate side effects

The most common side effect of acamprosate is diarrhea. Lack of energy and trouble sleeping are also possible. But studies show that acamprosate doesn’t cause these side effects more frequently than placebo (a pill with nothing in it).

More serious side effects of acamprosate include depression and suicidal thoughts. If you notice a change in your mood while using acamprosate, talk to your healthcare provider. And 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.

Disulfiram side effects

Disulfiram may cause numbness or tingling in the arms and legs, and skin irritation. It can also make you feel more tired or cause headaches. And it may cause an unusual aftertaste after you take it.

In rare cases, disulfiram can cause severe liver problems. Signs that you may be experiencing liver damage include abdominal pain, nausea and vomiting, and yellowing of the skin or eyes. Your urine also may appear darker than usual or you may feel extremely tired. If you notice any of these changes, contact your healthcare provider right away. They can help determine if these symptoms are due to liver problems or something else.

Can you take acamprosate and disulfiram together for AUD?

Some older research found that a combination of acamprosate and disulfiram helped reduce drinking compared to just taking acamprosate alone. But more research should be done to determine the benefits of this combination. 

Before starting any medications for AUD, talk to your healthcare provider about what might be the best option for you based on your individual preferences and medical history.

Who should avoid acamprosate and disulfiram?

People with severe kidney problems shouldn’t take acamprosate. And people with severe heart problems or psychotic conditions may need to avoid disulfiram. If you’ve taken a medication called metronidazole (Flagyl) in the last 2 weeks, you should also avoid disulfiram. And as mentioned, if you’ve had any alcoholic drinks or any alcohol-containing products in the last 12 hours, you should wait to take disulfiram until at least 12 more hours have passed.

If you have any questions about whether you should avoid acamprosate or disulfiram, talk to your healthcare provider. They can help determine if these medications are safe for you.

How to save on acamprosate and disulfiram

GoodRx can help you save over 70% off the average retail price of the generic versions of disulfiram and naltrexone. Generic acamprosate at certain pharmacies is as low as $68.17 with a free GoodRx discount. Generic oral disulfiram at certain pharmacies is as low as $33.59 with a free GoodRx discount.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She currently practices as a clinical pharmacist at Buffalo General Medical Center.

Edited 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.

Reviewed by:

Jonathan Avery, MD

Jonathan Avery, MD, is the current vice chair of addiction psychiatry and an associate professor of clinical psychiatry at Weill Cornell Medical College and New York-Presbyterian Hospital.

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