Medications for Alcohol Use Disorder
Medication can help reduce heavy drinking or support staying alcohol-free. Naltrexone, acamprosate and disulfiram work in different ways, and the choice depends on drinking goals, health and other medicines.
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Medications Can Help Treat Alcohol Use Disorder
Naltrexone, acamprosate and disulfiram are medications approved by the U.S. Food and Drug Administration (FDA) for alcohol use disorder (AUD). They have different roles. Naltrexone can reduce heavy drinking, acamprosate supports continued abstinence (not drinking), and disulfiram discourages drinking by causing a potentially dangerous reaction to alcohol.[1]
A 2023 review of 118 trials supported oral naltrexone and acamprosate as commonly recommended starting options alongside care such as counseling. Disulfiram has less consistent evidence and is generally considered for selected people seeking abstinence, especially when someone supports regular dosing.[2][3]
Asking about medication is a reasonable part of seeking treatment. You can discuss it with a primary care clinician or addiction specialist, even if no one has offered it before. Medication can fit alongside counseling and mutual-support groups.[1]
Get medical advice before stopping heavy, regular drinking. Withdrawal can cause seizures or severe confusion and can be life-threatening. Call 911 for a seizure, severe confusion or another medical emergency. A clinician can assess whether you need monitored withdrawal treatment. Medical withdrawal care may be needed before ongoing recovery medication.[4]
- There are three FDA-approved medicines. Naltrexone comes as a pill or monthly injection. Acamprosate and disulfiram are pills.[1]
- The options serve different goals. Oral naltrexone may suit reducing heavy drinking. Acamprosate is started after withdrawal when a person is abstinent.[5][6]
- Safety depends on your health and other medicines. Opioid use matters for naltrexone, kidney function for acamprosate, and avoiding alcohol for disulfiram.[6][7][8]
- The three approved medicines are nonaddictive. That does not mean they are free of side effects or suitable for everyone.[1]
- Semaglutide remains an emerging option. Two small trials found benefits on some drinking outcomes. It is not an established replacement for approved AUD treatment.[9][10]
How the FDA-Approved Medications Compare
The comparison below describes options to discuss with a prescriber. It separates the two naltrexone forms because their dosing and prescribing instructions differ. Expected benefit, withdrawal risk, other medicines and your ability to follow the schedule all matter.[5][7]
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| Medication | Main role | Starting treatment | Key consideration |
|---|---|---|---|
| Oral naltrexone | Can reduce alcohol’s rewarding effects and heavy drinking.[1] | A clinician may start it while a person is still drinking, with assessment of withdrawal risk.[5] | Recent opioid use can make starting it dangerous. Review opioid medicines and liver health first.[5][11] |
| Injectable naltrexone (Vivitrol) | A monthly alternative to taking a daily pill.[7] | Its FDA label says patients should not be actively drinking at the first injection.[7] | Requires a clinician-administered injection and an individualized plan if opioids were recently used.[7] |
| Acamprosate | Helps maintain abstinence after stopping alcohol.[6] | Started after withdrawal when abstinence has been achieved.[6] | Usually taken three times daily. Kidney impairment can require a lower dose or rule it out.[6] |
| Disulfiram | Discourages drinking through an alcohol reaction, rather than directly reducing cravings.[5] | Requires abstinence before starting and a clear plan to avoid alcohol.[8] | A reaction can occur for up to 14 days after the last dose. Supervised dosing may improve adherence.[5][8] |
These medicines do not work identically for everyone. A treatment plan should explain what improvement would look like, when to check progress, and what to do if side effects or practical barriers make the first choice difficult.[5]
Naltrexone Can Reduce Heavy Drinking
Naltrexone blocks opioid receptors involved in alcohol’s rewarding effects. It can reduce the urge to drink and the likelihood of heavy drinking. It does not cause the alcohol reaction associated with disulfiram, but it can cause nausea and other side effects.[1][11]
It is reasonable to ask for help with cravings. Tell your prescriber what you hope will change and what still feels difficult.
A 2010 review included 50 trials with 7,793 participants.[12] Naltrexone reduced the risk of heavy drinking to about 83% of the risk with placebo.[12] That is a relative risk of 0.83, or a 17% lower relative risk, not a claim that 83% of people stopped drinking.[12]
In the larger 2023 review, treating about 11 people with oral naltrexone at 50 mg daily prevented one additional return to heavy drinking compared with placebo.[2] This is an average across studies, not an individual guarantee.[2]
Choosing Between a Daily Pill and a Monthly Injection
Oral naltrexone is commonly prescribed as a 50 mg daily tablet.[5] Vivitrol is a 380 mg injection given by a healthcare professional every four weeks or once a month.[7] A monthly visit may help when remembering a daily pill is difficult.[5][7]
The choice involves more than strength. Discuss tolerability, insurance coverage, appointment access, injection-site effects and whether you prefer a daily medicine. Studies measure different outcomes, so the pill and injection should not be assumed to work identically for every person.[2][7]
Starting Naltrexone While Still Drinking
Clinical guidance allows oral naltrexone to start while a person is still drinking. A prescriber still needs to check withdrawal risk if drinking drops sharply. Naltrexone does not prevent or treat alcohol withdrawal.[5][11]
The Vivitrol label gives a different starting instruction: patients should not be actively drinking at the first injection. Discuss the plan for the specific form you are prescribed instead of assuming that advice about the pill also applies to the shot.[7]
Some approaches use targeted oral naltrexone rather than the same daily schedule. The studies do not all test the same protocol. A prescriber should set your schedule. Do not change your dosing or use naltrexone to manage withdrawal on your own.[11][13]
A trial of 121 adults with alcohol dependence used daily medication for 12 weeks, followed by 20 weeks of medication when craving alcohol.[13] Naltrexone helped when combined with coping-skills therapy but did not outperform placebo in the supportive-therapy groups. This was not a test of taking a pill only before drinking from the start.[13]
Opioid Use Must Be Reviewed Before Naltrexone
Naltrexone can trigger sudden, severe opioid withdrawal. Tell your prescriber about opioid pain medicines, tramadol, methadone, buprenorphine and nonprescribed opioids. Do not stop an opioid treatment medicine on your own to start naltrexone.[7][11]
The Vivitrol label recommends at least 7 to 10 opioid-free days after short-acting opioids. It warns that people transitioning from methadone or buprenorphine can remain vulnerable for up to two weeks. Those intervals are not a personal clearance rule. A prescriber must assess the transition and may arrange monitoring.[7]
Trying to overcome naltrexone’s blocking effect with more opioids can cause a fatal overdose. Opioid sensitivity can also increase after treatment stops or an injection is missed. Ask about overdose prevention, access to naloxone and how emergency pain treatment would be handled.[7][11]
Common side effects include nausea, stomach discomfort, dizziness and tiredness. Review liver or kidney disease, pregnancy, breastfeeding and all medicines with the prescriber. Seek prompt medical advice for yellow skin or eyes, dark urine or upper-right abdominal pain, which can indicate liver problems.[11]
Acamprosate Supports Abstinence After Stopping
Acamprosate helps people stay alcohol-free after withdrawal. Its exact mechanism is not fully understood. It may help restore the balance between brain signals that increase and decrease nerve activity after chronic alcohol exposure. It does not relieve acute alcohol withdrawal symptoms.[6]
A useful question is, “Once withdrawal is managed, what will help me keep going?”
A 2010 review of 24 trials involving 6,915 participants found that about nine people needed treatment for one additional person to avoid returning to any drinking.[14] It also found about an 11-percentage-point increase in the proportion of study days spent abstinent.[14] Those alcohol-free days could include both continuous and interrupted periods of abstinence.[14]
The 2023 review estimated that about 11 people needed acamprosate treatment to prevent one additional return to any drinking.[2] Reviews include different evidence and can produce different estimates. Both supported acamprosate for maintaining abstinence alongside counseling and other behavioral support.[2][14]
Kidney Function and Liver Health Affect the Choice
Acamprosate is eliminated through the kidneys rather than metabolized by the liver, so it may be an option when liver disease limits other medicines. It is not automatically the right choice for everyone with liver disease. Kidney function must be checked before prescribing.[5][6]
The label requires a reduced dose for moderate kidney impairment and rules out use in severe kidney impairment, defined there as creatinine clearance of 30 mL/min or less.[6] Naltrexone is not an automatic substitute because it also requires caution with kidney disease.[6][7]
Planning for Three Doses a Day
The usual acamprosate schedule is two 333 mg tablets three times daily, though kidney function can require a different dose.[6] Taking it with meals can help establish a routine. Follow your prescription rather than changing the schedule yourself.[6]
Diarrhea is a common side effect. Tell the prescriber if it is troublesome or persistent. Report new or worsening depression or suicidal thoughts promptly. If drinking resumes, contact the care team about the treatment plan rather than assuming that medication has failed or stopping it on your own.[6]
Disulfiram Requires a Plan to Avoid Alcohol
Disulfiram, also known by the brand name Antabuse, blocks the breakdown of acetaldehyde, a substance produced when the body processes alcohol. Drinking while taking it can cause flushing, vomiting, chest symptoms and a rapid heartbeat. Severe reactions can be life-threatening.[8]
Skipping a dose does not make drinking safe. A disulfiram-alcohol reaction can occur for up to 14 days after the last dose. Alcohol in some medicines, foods or other products can also cause a reaction. Ask a pharmacist which products to avoid.[8]
Supported Dosing Can Help, but Safety Comes First
Disulfiram may suit someone whose goal is abstinence and who understands the risks. Research is more favorable when doses are supervised, while evidence outside supervised settings is limited. A willing support person or clinic can help with the routine. Never give it to someone without their knowledge.[3][5][8]
A clinician must review heart, liver and other health conditions and possible drug interactions before prescribing. Liver injury can occur even without drinking, and monitoring may be needed. The label requires at least 12 hours without alcohol before the first dose, with an appropriate clinical assessment.[8]
Call 911 for severe trouble breathing, chest pain, collapse or a seizure after an alcohol reaction. Do not test whether you can drink on disulfiram.[8]
Off-Label Medications May Be Options
Clinicians sometimes prescribe medicines approved for another condition to treat AUD. This is called off-label prescribing. Topiramate and gabapentin have research support and may be discussed when first-line options do not fit. Evidence and risks vary by medicine.[5][15]
In a 2020 gabapentin trial, 27% of evaluable participants had no heavy-drinking days, compared with 9% receiving placebo.[16] The study lasted 16 weeks and enrolled people with recent withdrawal symptoms after three abstinent days. Benefit was concentrated among those with more withdrawal symptoms. These results do not establish a home-detox plan.[16]
Scroll sideways to compare all columns. With the table focused, use the left and right arrow keys.
| Medicine | Potential role | Evidence and cautions |
|---|---|---|
| Topiramate | May reduce heavy drinking. | Research supports benefit, but tingling and side effects affecting memory or thinking can affect tolerability. Clinicians generally increase the dose gradually.[5] |
| Gabapentin | May help selected people reduce drinking, including some with withdrawal-related sleep or anxiety symptoms. | Can cause dizziness and has misuse potential. Combining it with opioids or other sedating substances requires particular caution.[5][16] |
| Baclofen | An alternative studied for AUD, including in people with liver disease. | Evidence is mixed. Specialist assessment is important because benefit and tolerability vary. Sedation is a concern, especially with alcohol.[5][17] |
| Ondansetron | An investigational approach studied in selected groups, including people with early-onset alcohol problems. | Limited findings do not make it a routine first choice. Study results should not be generalized to everyone with AUD.[17] |
What Semaglutide Studies Show So Far
Semaglutide, the medicine in Ozempic and Wegovy, is being studied for alcohol use disorder. These GLP-1 medicines have established uses outside AUD. Findings about alcohol are promising but remain an emerging area of treatment research.[9][10]
A 2025 trial randomized 48 adults with AUD who were not seeking treatment.[9] Over nine weeks, low-dose semaglutide reduced alcohol consumed in a laboratory task and some measures of craving and drinking. It did not significantly reduce average drinks per calendar day or the number of drinking days.[9]
A 2026 trial involved 108 treatment-seeking adults with moderate-to-severe AUD and obesity. Everyone received cognitive behavioral therapy. After 26 weeks, semaglutide produced a greater reduction in the percentage of heavy-drinking days than placebo. Stomach-related side effects were more common with semaglutide.[10]
The 2026 result applies to the population studied, not automatically to people without obesity. These trials do not establish long-term outcomes or prove that semaglutide replaces approved AUD medicines. Discuss GLP-1 research for alcohol use disorder with a clinician rather than starting or changing treatment yourself.[9][10]
Which Medication Fits Your Situation
A clinician can help match treatment to your goals, health and preferences. Share how much and how often you drink, previous withdrawal symptoms, other drug use, current medicines, and any pregnancy or breastfeeding considerations.[5][11]
Try, “I want help changing my drinking. Could we talk about medication as well as counseling?”
- If your goal is to reduce heavy drinking, ask whether oral naltrexone fits your situation and whether reducing alcohol will require withdrawal care.[5]
- If you have already stopped, acamprosate or naltrexone may help support your next stage of recovery.[2]
- If you use opioid medicines, discuss alternatives to naltrexone and coordination with your opioid prescriber. Do not arrange a transition on your own.[7][11]
- If you have liver or kidney disease, ask how test results affect selection and monitoring. There is no automatic swap that is safe for everyone.[6][7][8]
- If sleep problems or withdrawal history complicate recovery, ask whether gabapentin or another approach is appropriate after assessment.[5][16]
- If abstinence is your goal and daily support is available, ask whether supervised disulfiram is appropriate and how to avoid an alcohol reaction.[5][8]
Family history is useful background, but it does not by itself determine which medication to use. Research on genetic matching has not produced findings robust enough for routine medication selection.[15]
Access to Alcohol Medication Remains Uneven
Medication has historically been underused. An analysis of the 2019 U.S. national survey found that 7.3% of adults with past-year AUD reported receiving alcohol treatment in the past year, and 1.6% reported using medication.[18] Those figures describe 2019, not the current treatment rate.[3]
A review of 23 studies identified barriers including limited knowledge, concerns about prescribing, stigma, treatment philosophy and difficulty accessing medicines. A separate 2016 survey of 475 physicians found that most said additional training would increase their use of AUD medications. Neither finding means every clinician has the same barriers.[19][20]
A 2026 study examined U.S. treatment-facility availability from 2017 through 2023. Counties with at least one substance use treatment facility offering AUD medication increased from about 34% in 2017 to 44% in 2021, then growth plateaued.[21] Rural counties had lower availability. This measures facility availability, not whether every patient could obtain treatment.[21]
Ask About the Full Cost Before Starting
Cost and insurance restrictions can affect access.[19]
Ask the prescriber and pharmacist about the price of the medicine, any required visits or injections, laboratory testing and follow-up. Check coverage with your insurer and ask whether a generic option or assistance program is available. Do not assume an advertised price is your total cost.
Finding a Prescriber Near You or Online
You can begin with primary care, an addiction specialist or an alcohol treatment program. Some services provide medication visits by telehealth. Ask specifically whether the service prescribes AUD medication, rather than assuming that a therapy appointment includes prescribing.[1]
Addiction medicine physician Sarah Wakeman told The Pew Charitable Trusts why alcohol treatment needs to extend beyond specialist services: “There’s no way we’ll ever address the crisis of alcohol use disorder if we expect only specialists to treat this.”[22]
At your next visit, ask who can assess you for medication, who will manage follow-up, and whether another clinician needs to be involved. If the practice cannot provide this care, ask for help making that connection.
To look for care near you, use the NIAAA Alcohol Treatment Navigator or contact your insurer. Confirm current availability, costs, credentials and how the provider coordinates medication with counseling. If you use telehealth, ask how withdrawal assessment and any necessary in-person care will be arranged.[1]
Bring a list of medicines and a description of your drinking pattern. Ask what the medicine is expected to help with, what side effects need urgent attention, and when you will review progress. Your alcohol use self-assessment may help start a conversation, but it does not replace a clinical assessment.[5]
Getting Help and Starting Medication
Medication can be one part of effective alcohol treatment. The aim is to find a plan you can follow that addresses drinking goals, physical health and support needs. If the first approach is difficult or ineffective, tell the care team so you can discuss adjustments.[1]
- Explore the full picture of alcohol use disorder and treatment.
- Understand alcohol withdrawal symptoms and when medical care is urgent.
- Learn how alcohol detox fits with continuing treatment.
- Discuss targeted naltrexone or GLP-1 research with a prescriber before changing your plan.
Ready to compare care options?
If you are in crisis or thinking about suicide, call or text 988 or use the 988 Lifeline chat.[23]
Frequently asked questions
Do Medications for Alcohol Use Disorder Work?
Yes. Oral naltrexone and acamprosate have evidence supporting them as commonly recommended starting options alongside care such as counseling. Naltrexone can reduce heavy drinking, while acamprosate helps maintain abstinence. Disulfiram has less consistent evidence and may suit selected people with supported dosing. No medicine guarantees recovery.[2][3]
What Is the Best Medication for Alcohol Use Disorder?
There is no single best choice. Drinking goals, withdrawal risk, opioid use, liver and kidney health, other medicines and your preferred schedule all matter. A prescriber may discuss oral naltrexone for reducing heavy drinking, acamprosate after stopping, or another option if those do not fit.[5]
Can I Take Naltrexone While I Am Still Drinking?
A clinician may start oral naltrexone while you are still drinking, after checking withdrawal risk and other safety factors. The Vivitrol injection label says you should not be actively drinking at the first injection. Both forms require careful review of recent opioid use because naltrexone can trigger severe opioid withdrawal.[5][7][11]
Do not stop methadone, buprenorphine or another prescribed opioid on your own to begin naltrexone. Your prescriber must plan any transition. A general number of opioid-free days cannot establish that it is safe for you.[7][11]
What Is the Difference Between Naltrexone and Acamprosate?
Naltrexone blocks opioid receptors involved in alcohol’s rewarding effects and can reduce heavy drinking. Acamprosate helps maintain abstinence after withdrawal. Acamprosate requires adequate kidney function, while naltrexone requires review of opioid use and liver health. Neither is an automatic choice solely because you have liver or kidney disease.[1][6][7]
Are Medications for Alcohol Cravings Addictive?
Naltrexone, acamprosate and disulfiram are nonaddictive. They still have side effects and require a suitability assessment. Disulfiram discourages drinking through an alcohol reaction rather than directly treating cravings. Gabapentin, an off-label option, has misuse potential and requires particular caution with opioids or other sedating substances.[1][5]
Can Ozempic or Wegovy Treat Alcohol Use Disorder?
Semaglutide has shown benefits on some drinking outcomes in two small trials, but it remains an emerging AUD treatment. The 2025 trial included 48 adults.[9] The 2026 trial included 108 adults with AUD and obesity who also received counseling.[10] These findings do not establish benefit for everyone or replace a discussion of approved AUD medicines.[9][10]
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