Naltrexone (ReVia and Vivitrol), acamprosate (Campral), disulfiram (Antabuse), and topiramate (Topamax, Trokendi XR, and Qudexy XR) are all medications that could potentially help you stop drinking when used in conjunction with therapy.
The Need for Comprehensive Treatment
An alcohol use disorder is defined as a pattern of continued drinking in spite of the negative impacts on a person’s quality of life  It is characterized by cravings for alcohol and continued drinking despite its negative impact on physical or mental health and/or on a person’s ability to function.
Alcohol use disorder is a problem for almost 15 million Americans, according to the 2019 National Survey on Drug Use and Health (NSDUH). It affects about 9 million men and 5.5 million women.
There is no cure for alcohol use disorders at any level, but there are a number of therapies – both medications and behavioral therapies – that have been proven to reduce alcohol use.
Top Medications to Help Stop Drinking
Naltrexone (ReVia & Vivitrol)
- How it works: Naltrexone may be taken as a pill one time per day or as a shot given by a doctor once per month.
- How it helps: Both the shot and the pill version of naltrexone help to reduce cravings for alcohol but affect the brain’s reward pathways.
- Benefits: The shot version of the drug is a great choice for those who struggle to remember to take a pill every day and those who are not in a situation where they can manage daily medications.
- Efficacy: Naltrexone works by blocking the mu-opioid receptor in the brain, preventing the person who drinks from experiencing any of the “buzz” associated with ingestion of the substance. However, not everyone’s mu-opioid receptor is created by the same gene. Different genes can create different structures in the mu-opioid that can change its efficacy, so the drug may work better in some people than others.
- Side effects: Naltrexone generally has very few side effects and is very well tolerated. Some people may experience mild nausea or GI upset, but this is unusual. People with advanced liver disease also may not be able to use this medication. If used in conjunction with opioid medications, it can cause a precipitated withdrawal, so it should not be used alongside any opioid medications.
- Considerations: The shot is more expensive than pills, and not all insurance providers will cover the full cost. Some people may also not like the idea of injections in which case the pill form might be preferable.
- How it works: Acamprosate helps to curb cravings for alcohol. It is a pill taken usually 3 times per day.
- How it helps: Acamprosate may cut down on the experience of withdrawal symptoms in those who go from drinking heavily to abstinence in a short period of time.
- Benefits: With fewer withdrawal symptoms to deal with, those who take acamprosate may more quickly be able to turn their attention to the therapies that will help them heal.
- Efficacy: Acamprosate has been shown to be more effective than placebo in helping people to avoid initial relapse, but it has not been shown to be helpful in limiting drinking on heavy drinking days.
- Side effects: This medication generally has few side effects. It may be unsafe to use in certain patients who have advanced liver or kidney disease.
- Considerations: More research is needed to fully understand how acamprosate works, but it has a solid safety profile and may be a good choice for a wide range of patients.
- How it works: Disulfiram is prescribed in pill form and usually taken one time per day. It works differently than Acamprosate and Naltrexone, which both curb cravings for alcohol use. Instead, Disulfiram works by causing negative physical effects if someone drinks alcohol while taking it. These effects can last for an hour or more. They will make the person feel sweaty, cause nausea and vomiting, and shakiness. This disincentivizes the person for drinking.
- How it helps: The knowledge that drinking while on this medication could cause any combination of nausea, headache, chest pain, and vomiting is often enough to deter people from drinking.
- Benefits: For many people who take the drug, it can feel like a protective measure that keeps them from relapsing during the toughest parts of recovery and beyond. This is considered to be a second line form of treatment, providing an option for people who cannot take naltrexone or acamprosate.
- Efficacy: Disulfiram works by making the person feel sick if they drink alcohol, but it does not curb cravings on its own. This medication was one of the first treatments we had for AUD before newer agents like Naltrexone and acamprosate were available. These days, it has fallen out of favor and is not considered first line treatment for AUD. However, it still may be a good choice for some individuals or for those who cannot have Naltrexone, Acamprosate or Topiramate for any other reason.
- Side effects: For those who struggle with mental health issues or severe heart disease, this medication is not recommended. It may also cause liver damage, and people who have significant liver problems should not take it. Other side effects may include headache, acne, rash, drowsiness, and impotence. It may also cause people to adversely react to certain other medications or foods – certain cheeses or foods with certain chemicals can also provoke the “disulfiram sickness reaction”.
- Considerations: It is important to wait at least 12 hours after last ingesting alcohol before taking the first dose of this drug.
Topiramate (Topamax, Trokendi XR & Qudexy XR)
- How it works: Though this drug is the only one on the list that is not FDA approved specifically for the treatment of alcohol use disorder, some doctors find that it is effective for this purpose because it helps to rebalance dopamine and GABA, an inhibitory neurotransmitter, that may be unsettled after long-term alcohol misuse. It is therefore used “off label”, sometimes in conjunction with the other medications above, to treat AUD.
- How it helps: By decreasing the sense of pleasure that a person experiences when drinking, the act of drinking itself may be less desirable. It curbs cravings to use alcohol.
- Benefits: When alcohol use no longer feels good, it may no longer feel like a feasible coping mechanism for people who routinely use the substance to manage uncomfortable feelings. This makes it easier to focus on more positive coping mechanisms, such as therapy.
- Efficacy: There are a number of studies that show that topiramate can help to manage anxiety and other mood fluctuations that result in recovery while also reducing the pleasure experienced when drinking.
- Side effects: Other side effects may include fever, weight loss, lack of appetite, loss of memory/mental “fogginess”.
- Considerations: This drug is also used for weight loss, seizures, headaches, and certain mood/psychiatric conditions, so it may be doubly beneficial if you suffer from any of these other conditions.
Tips for Using Medications to Treat Alcohol Use Disorder
Medications can be a critical piece of an overall treatment plan to help someone stop drinking and remain sober, but there are a few things to be aware of before using medication to treat AUD:
- All of these medications require a doctor’s prescription and ongoing supervision. These are not to be taken without medical care and guidance.
- While some individuals are able to fully abstain from drinking with medications alone, we know that medications are most likely to be effective when combined with support groups and talk therapy and other forms of behavioral support. 
- Not all medications will be a good fit for each person, even if a medication has been shown to be effective for the treatment of alcohol use disorder for some people.
- It can take time to determine the right dose and/or combination of medications when taking prescription drugs to treat AUD. Just like any medication, it can take months to try a low dose and incrementally add onto that dose to find what works. Have patience!
- Over time, even if a medication is effective, it may be necessary to switch to another medication if there are complications, side effects, or efficacy declines.
Medically Reviewed By: Elena Hill, MD, MPH
- Diagnosis and Pharmacotherapy for Alcohol Use Disorder: A Review. JAMA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391072/. July 2020. Accessed December 2022.
- Alcohol Facts and Statistics: Alcohol Use in the United States. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics. March 2022. Accessed December 2022.
- Three Genes Predict Success of Naltrexone in Alcohol Dependence Treatment. Medical University of South Carolina. https://web.musc.edu/about/news-center/2020/09/23/anton-naltrexone. September 2020. Accessed December 2022.
- Acamprosate for Treatment of Alcohol Dependence: Mechanisms, Efficacy, and Clinical Utility. Therapeutics and Clinical Risk Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277871/. February 2012. Accessed December 2022.
- Disulfiram. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK459340/ October 2022. Accessed December 2022.
- Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review. Journal of Addiction Medicine. https://journals.lww.com/journaladdictionmedicine/Abstract/2019/02000/Topiramate_Pharmacotherapy_for_Alcohol_Use.4.aspx . January/February 2019. Accessed December 2022.
- Pharmacotherapy for Alcohol Use Disorder: Current and Emerging Therapies. Harvard Review of Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790835/. March 2016. Accessed December 2022.
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