Medicines for alcohol use disorder are among the most underused treatments in medicine. Two of the best studied are naltrexone and acamprosate (Campral). They work differently and suit different goals.
Naltrexone
Naltrexone blocks part of the rewarding effect of alcohol, which can reduce cravings and heavy drinking days. It comes as a daily pill or a monthly injection (Vivitrol). It is a good fit if your goal is to cut back or stop. Naltrexone cannot be taken with any opioid, including opioid pain medicines, buprenorphine or methadone; it causes sudden withdrawal and blocks opioid pain relief in an emergency. Your liver tests are checked.
Acamprosate
Acamprosate helps people who have stopped drinking stay sober. It is usually started after you have stopped drinking. It is taken three times a day and is cleared by the kidneys, so the dose depends on kidney function and it is not used with severe kidney disease. Because it is not processed by the liver, it can be used in people with liver disease.
Choosing between them
- Want to cut back, or still drinking: naltrexone is often first
- Already stopped and want to stay stopped: either works; acamprosate is a strong choice
- Taking opioids or buprenorphine: acamprosate, not naltrexone
- Liver disease: acamprosate is often preferred
- Kidney disease: naltrexone is often preferred
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Confidential, evidence-based care in West Ashley. New patients are often able to be scheduled within a week of requesting an appointment.
Medicine works best with support
Counseling, support groups and treatment of anxiety, depression or sleep problems make these medicines more effective.
If you drink heavily every day, do not stop suddenly before talking with a medical provider. Alcohol withdrawal can cause seizures and delirium tremens, which can be fatal. Call 911 for a seizure, confusion, hallucinations, or fever with shaking and a racing heart.
Learn more about alcohol use disorder treatment in Charleston.
Help at Hope Addiction Medicine
Our team combines medication with counseling and behavioral therapies, in person at our West Ashley office in Charleston and by telehealth when appropriate. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment or call our office.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If someone may be overdosing, call 911 and give naloxone if you have it.
Frequently Asked Questions
Naltrexone and acamprosate (Campral) are two of the best studied. Naltrexone reduces cravings and heavy drinking; acamprosate supports staying sober after stopping.
Naltrexone is sometimes started while people are still drinking, with a goal of cutting back or stopping, because it reduces alcohol's reward. Follow your provider's plan.
Acamprosate is cleared by the kidneys rather than the liver, so it is often preferred for people with liver disease. The dose depends on kidney function, and it is not used with severe kidney disease.