Medications for Alcohol Use Disorder: Naltrexone vs. Acamprosate vs. Disulfiram (Antabuse) vs. Gabapentin

‍Quick answer: Three medications are FDA-approved for alcohol use disorder: naltrexone, acamprosate (Campral) and disulfiram (Antabuse). Naltrexone and acamprosate are the first choices for most people; naltrexone reduces cravings and the reward of drinking, while acamprosate eases the discomfort that follows quitting. Antabuse makes drinking cause a severe reaction. Gabapentin and topiramate are off-label options.

Yet only about 2.5% of the 28 million people in the U.S. with alcohol use disorder received medication for it in 2024 (NIAAA). This guide compares each option so you can have an informed conversation with your provider. To talk with one today, call MATClinics at 410-220-0720 or schedule an appointment.

Alcohol Use Disorder Medications at a Glance

• Naltrexone (tablet or monthly Vivitrol® shot): Reduces cravings and the pleasure of drinking. Works for cutting back or quitting. Avoid if you need opioids or have acute liver failure. FDA-approved.
• Acamprosate (Campral): Eases the restlessness, anxiety and poor sleep that can follow quitting. Best for staying alcohol-free after you've stopped. Safe for the liver; not for severe kidney disease. Taken three times a day. FDA-approved.
• Disulfiram (Antabuse): Causes a severe, unpleasant reaction if you drink. Only for people committed to not drinking at all. Daily tablet. FDA-approved.
• Gabapentin: Can reduce cravings, anxiety and sleep problems. Prescribed off-label.
• Topiramate: Can reduce heavy drinking days. Prescribed off-label.

The American Psychiatric Association recommends naltrexone or acamprosate first for moderate to severe alcohol use disorder, with disulfiram, topiramate or gabapentin as options when those aren't a fit (APA guideline summary).

Naltrexone

Naltrexone blocks opioid receptors in the brain that help create the "reward" from alcohol. With that reward dulled, cravings ease and drinks feel less satisfying, which helps people drink less or stop.

• How it's taken: A 50 mg tablet once a day, or Vivitrol, a 380 mg injection given every four weeks.
• Best for: People who want to cut back or quit, including those still drinking when they start. It also treats opioid use disorder, which helps people who have both.
• Common side effects: Nausea, headache, dizziness, fatigue and trouble sleeping, usually fading within a couple of weeks.
• Who shouldn't take it: Anyone who takes or needs opioid pain medicine, and people with acute hepatitis or liver failure.

MATClinics offers Vivitrol treatment for alcohol use disorder. Learn more in our guide to naltrexone and Vivitrol side effects (link when published).

Acamprosate (Campral)

Acamprosate helps people stay alcohol-free after they've stopped drinking. Long-term heavy drinking throws off the balance between the brain's calming and excitatory chemicals. After quitting, that imbalance can cause lingering restlessness, anxiety and poor sleep that make relapse more tempting. Acamprosate is thought to help restore that balance.

• How it's taken: Two 333 mg tablets three times a day (666 mg per dose), with or without food. While brand-name Campral was discontinued by its manufacturer, generic acamprosate is widely available and routinely prescribed. Best for: People who have already stopped drinking and want to stay stopped. The label notes it wasn't shown to work in people who hadn't stopped drinking first.
• Liver-friendly: Acamprosate isn't processed by the liver, making it a good option for people with liver disease.
• Common side effects: Diarrhea is the most common, reported by 16% of people in trials (vs. 10% on placebo). Others include nausea and itching.
• Who shouldn't take it: People with severe kidney disease. People with moderate kidney problems need a lower dose.
• Mood: As with other alcohol medications, providers watch for depression or suicidal thoughts, which were slightly more common on acamprosate than placebo in trials.

The three-times-daily schedule is the biggest drawback. Pill organizers or phone reminders can help. Source: acamprosate prescribing information.

Disulfiram (Antabuse)

Disulfiram works differently from the other medications. It doesn't reduce cravings. Instead, it blocks the body from breaking down alcohol, so even a small drink causes flushing, a pounding headache, nausea, vomiting, sweating and a racing heart. The idea is that knowing this will happen makes drinking a far less appealing choice.

• How it's taken: A daily tablet, usually 250 mg, started at least 12 hours after the last drink.
• Best for: Highly motivated people committed to not drinking at all, especially when someone they trust helps make sure the dose is taken each day.
• Lasting effect: A reaction can still happen up to 14 days after the last dose.
• Hidden alcohol: People on disulfiram need to avoid alcohol in sauces, vinegars, cough syrups and products like aftershave.
• Common side effects: Drowsiness, fatigue, headache, skin rash and a metallic or garlic-like taste, mostly in the first two weeks.
• Serious risks: Severe reactions to alcohol can be dangerous, and rare but serious liver injury can occur, so providers check liver tests.
• Who shouldn't take it: People with serious heart disease or psychosis, or anyone who recently took metronidazole.

The label is clear that disulfiram must never be given to someone without their full knowledge (disulfiram prescribing information).

Naltrexone vs. Antabuse

Naltrexone reduces the urge to drink, while Antabuse punishes drinking. Naltrexone works whether your goal is cutting back or quitting; Antabuse only fits a goal of no alcohol at all. For most people, naltrexone is easier to stay on, which is why guidelines suggest trying it first.

Gabapentin and Topiramate (Off-Label Options)

Gabapentin and topiramate aren't FDA-approved for alcohol use disorder, but the APA guideline lists both as options when naltrexone and acamprosate don't work or aren't tolerated. "Off-label" means a provider prescribes an approved drug for a use not on its label, based on research and clinical judgment.

Gabapentin

Gabapentin is an anticonvulsant and nerve-pain medication. For alcohol use disorder, it can help with cravings, anxiety and sleep problems, especially in the weeks after someone stops drinking.

• Common side effects: Dizziness, drowsiness and fatigue.
• Things to know: Some people misuse gabapentin, particularly people who also use opioids, so providers prescribe it carefully. Stopping it suddenly after regular use can cause withdrawal symptoms.

Is It Safe to Mix Gabapentin and Alcohol?

Gabapentin and alcohol both slow down the brain. Taking them together increases drowsiness, dizziness and impaired coordination, and raises the risk of falls and dangerous breathing problems, especially when opioids or sedatives are involved too. If you're prescribed gabapentin, talk to your provider honestly about your drinking.

Topiramate

Topiramate is a seizure and migraine medication that can reduce heavy drinking days. It's usually started at a low dose and increased slowly.

• Common side effects: Tingling in the hands and feet, trouble concentrating or finding words, changes in taste and weight loss.
• Things to know: It can cause kidney stones and isn't recommended during pregnancy.

Emerging Research: GLP-1 Medications Like Ozempic

GLP-1 medications such as semaglutide (Ozempic, Wegovy) are approved for diabetes and weight loss, and researchers are now testing whether they reduce drinking too. Early results are promising, but they are not FDA-approved for alcohol use disorder.

• 2026 oral semaglutide trial: In a small phase 2 study of 50 adults with moderate to severe alcohol use disorder, eight weeks of daily oral semaglutide reduced heavy drinking days compared with placebo. By the end, 81% on semaglutide had moved down at least one risk-drinking level, versus about 54% on placebo (American Psychiatric Association).
• 2026 Lancet trial: A randomized trial published in The Lancet tested once-weekly semaglutide in people with alcohol use disorder and obesity (The Lancet).

Researchers say larger trials are still needed. If you already take a GLP-1 and notice changes in your drinking, tell your provider. For a deeper look, see our upcoming post on GLP-1s and alcohol cravings.

How to Choose the Right Medication for Alcohol Use Disorder

The best medication is the one that fits your goals and health and that you'll actually take. Your provider will consider:

• Your goal: Cutting back points toward naltrexone. Staying fully alcohol-free fits naltrexone, acamprosate or disulfiram.
• Whether you've stopped drinking yet: Acamprosate and disulfiram work best once you've stopped. Naltrexone can be started while you're still drinking.
• Your liver and kidneys: Acamprosate is often preferred with liver disease. Naltrexone may be preferred with kidney disease.
• Opioid use: If you take or need opioids, naltrexone isn't an option. If you also have opioid use disorder, naltrexone or Vivitrol can treat both.
• Your routine: A monthly Vivitrol shot removes daily pill-taking. Acamprosate needs three doses a day.
• Past experience: If one medication didn't work or caused side effects, another often will.

Medication works best alongside counseling and support, not instead of it.

How MATClinics Can Help

MATClinics provides outpatient treatment for alcohol use disorder at eight locations across Maryland and through telemedicine. Our providers help you choose and manage medication-assisted treatment, including Vivitrol, alongside substance use counseling, mental health therapy and psychiatry.

We accept all Maryland Medicaid plans, Medicare Part B and CareFirst, offer evening and Saturday hours and often see new patients the same day. Call 410-220-0720 or schedule an appointment.

Why So Few People Get Medication for Alcohol Use Disorder

Alcohol use disorder medications have been available for decades, yet they remain among the most underused treatments in medicine. According to NIAAA, about 28 million people ages 12 and older had alcohol use disorder in 2024. Only 7.6% received any treatment, and just 2.5% received medication.

Common reasons include:

• Not knowing medication exists. Many people, and some clinicians, still think the only options are willpower, rehab or 12-step groups.
• Stigma. Some see taking medication as "trading one drug for another." The three FDA-approved medications aren't addictive and don't produce a high.
• Thinking you have to hit rock bottom first. Medication helps at every stage, including for people trying to cut back.
• Limited access. Fewer providers offer these medications than opioid treatment, and some people don't know where to start.

Learn more about why medication-assisted treatment works in What Is MAT?

Frequently Asked Questions About Alcohol Use Disorder Medications

What Is Acamprosate Used For?

Acamprosate helps people who have stopped drinking stay alcohol-free by easing the restlessness, anxiety and sleep problems that can follow quitting.

Which Is Better, Naltrexone or Acamprosate?

Both are recommended first choices. Naltrexone is often preferred if you want to cut back or are still drinking. Acamprosate is often preferred if you've already stopped, or if you have liver disease.

Can You Drink on Antabuse?

No. Drinking on disulfiram causes a severe reaction, including vomiting, a racing heart and low blood pressure, and it can be dangerous. A reaction can happen up to two weeks after your last dose.

Does Gabapentin Help With Alcohol Cravings?

It can. Gabapentin is prescribed off-label to reduce cravings, anxiety and sleep problems, but it shouldn't be mixed with alcohol.

Can You Take Naltrexone and Acamprosate Together?

Sometimes. Providers may combine them in certain cases. Talk with your provider about whether that makes sense for you.

Is Medication for Alcohol Use Disorder Covered by Insurance?

Most plans, including Maryland Medicaid, cover naltrexone, acamprosate and disulfiram. Coverage for Vivitrol may require prior authorization. Check with your plan or ask our team.

How Long Do You Stay on Alcohol Medication?

Many people take it for at least several months to a year, and some longer. You and your provider decide based on how you're doing.