Which Medications Work Best to Help Me Stop Drinking? - GoodRx (2024)

Alcohol use disorder (AUD) is complex. It's a medical condition where a person has difficulty controlling their alcohol use. A combination of therapy, support groups, and medications can help treat AUD.

Here, we’ll cover five of the most common and effective medications to help you stop drinking.

1. Naltrexone

Naltrexone (Vivitrol) is a first-choice option for moderate to severe AUD, according to the American Psychiatric Association (APA). It may help people who want to stop drinking alcohol completely (abstinence) or who just want to drink less (moderation).

How it works

Naltrexone is an opioid blocker. When you drink alcohol, your body releases endogenous (natural) opioids and a chemical called dopamine. Having an excessive amount of opioids and dopamine in the body can lead to addiction and dependence.

By blocking areas of the body where opioids attach (opioid receptors), naltrexone blocks the rewarding effects of alcohol. Alcohol becomes less enjoyable and cravings for alcohol decrease.

How to take it

Naltrexone comes as a generic once-daily tablet or a brand-name, once-monthly injection (Vivitrol). The usual starting dose is 50 mg per day. The injection is given intramuscularly (IM) into your buttock muscle by a healthcare provider. The usual dose is 380 mg every 4 weeks.

We don't know exactly how long you should take naltrexone. Some studies show that when naltrexone is stopped, any benefit may be lost. If it works for you, your healthcare provider might recommend you stay on it for at least one year.

Effectiveness

Naltrexone is considered effective at improving outcomes in AUD. Though some studies have shown oral naltrexone doesn't reduce drinking, most studies have found that it does. But it’s not clear whether oral naltrexone helps people stay away from alcohol entirely (avoid a relapse), or whether it’s effective at reducing drinking after you stop taking.

IM naltrexone has also been shown to reduce heavy drinking. This may be more likely for men versus women, as well as for people who stop drinking before starting naltrexone.

Research comparing oral and IM naltrexone shows conflicting results. For example, one study found that people taking IM naltrexone had a longer time to relapse than those taking oral naltrexone. But another study found that IM naltrexone didn’t lead to less alcohol-related hospital admissions than oral naltrexone.

One benefit of IM naltrexone is that you only need a dose every 4 weeks. So if you have trouble taking pills, this may be a good option. But if you think you’ll have trouble making it to your provider’s office every month, pills may be a better option.

Side effects

Oral and IM naltrexone can cause some common side effects. These include:

• Nausea and vomiting

• Appetite changes

• Headache

• Increased liver enzymes

• Dizziness

• Restlessness

More serious side effects include:

• Liver damage

• Depression and thoughts of self-harm or suicide

• Opioid withdrawal if you take it within 7 to 10 days of an opioid

• Injection site reactions or serious allergic reactions with IM naltrexone

You shouldn’t use naltrexone if you have liver failure or acute hepatitis. And if you experience worsening depression or changes in behavior while taking naltrexone, let your healthcare provider know right away.

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.

2. Acamprosate

Like naltrexone, acamprosate is considered a first-choice option for moderate-to-severe AUD. It’s often used instead of naltrexone in people with liver problems, or in people who use opioids and can’t take naltrexone.

How it works

We don’t know exactly how acamprosate works. But we do know that AUD can change your brain chemistry. Acamprosate may help correct these alcohol-induced changes. This can reduce symptoms of alcohol withdrawal and help lower cravings.

How to take it

This medication comes as a tablet. The usual dosage is 2 tablets 3 times a day. It’s meant to be started after you’ve quit drinking. But if you relapse while taking acamprosate, you may be able to continue taking it.

Let your healthcare provider know if you have any existing kidney problems. You may need a lower dosage of 1 tablet 3 times a day. But if you have severe kidney damage, acamprosate isn’t a good option for you.

Effectiveness

Several studies have found that acamprosate is effective at helping people reduce alcohol use. This effect may continue after acamprosate is stopped. But research shows that people have trouble taking acamprosate as often as needed. In turn, this lowers its chances of working.

Some studies show naltrexone is better at reducing heavy drinking and cravings for alcohol than acamprosate. But acamprosate may lead to fewer relapses. Other small studies show that naltrexone is more effective than acamprosate in many ways including reducing the relapse rate. And yet other studies have found no difference between the two medications.

Side effects

Acamprosate can cause some common side effects, including:

• Diarrhea

• Trouble sleeping

• Anxiety

• Tiredness

• Depression

• Dizziness

More serious side effects may include suicidal thoughts or behavior.

3. Disulfiram

Disulfiram is the oldest FDA-approved medication for AUD. You may be familiar with the brand-name, Antabuse, though it’s no longer available.

While naltrexone or acamprosate are considered the preferred medications for AUD, disulfiram may be a good option for some people. This includes those who don’t do well on naltrexone or acamprosate.

How it works

Disulfiram is an alcohol blocker. It prevents alcohol from being broken down (metabolized) by the liver. If you drink alcohol while taking disulfiram, it causes a “disulfiram-alcohol reaction.” This is an unpleasant reaction to alcohol that helps discourage drinking. The reaction could even happen as late as 2 weeks after your last dose of disulfiram.

We’ll talk more about this unpleasant reaction later.

How to take it

Disulfiram is a tablet that’s usually taken once in the morning. It may be started at 500 mg per day, then decreased to 250 mg per day after 1 to 2 weeks. If it makes you tired, you can take it in the evening.

Disulfiram starts working within a few hours. So you should be alcohol-free for at least 12 hours before starting disulfiram. This includes any products that include alcohol, like some over-the-counter (OTC) cough syrups or mouthwashes.

Effectiveness

Research suggests that disulfiram can reduce drinking. But taking it under supervision may be key to its success. Some studies show that it’s more effective than acamprosate and naltrexone when you take it supervised by a family member or as part of a program, for example.

Without supervision, disulfiram may not be as effective. This is likely because many people have trouble taking disulfiram regularly, which makes it less effective.

Side effects

Most of the common disulfiram side effects improve or go away after about 2 weeks. They may include:

• Numbness

• Skin irritation, including rashes

• Headache

• Drowsiness

• Sexual problems like erectile dysfunction

• An unusual aftertaste

Disulfiram can also cause more serious side effects. This includes a disulfiram-alcohol reaction that may occur if you drink alcohol while taking disulfiram. If you drink alcohol while taking disulfiram, you may experience:

• Flushing

• Nausea

• Vomiting

• Difficulty breathing

• Sweating

• Low blood pressure

• Heart palpitations

These symptoms usually last for a maximum of 60 minutes, but they can last hours in severe cases and may be life-threatening (though this is rare). You should never give disulfiram to someone without them knowing or give it to someone who is drunk.

Disulfiram can also cause liver damage (especially if you have existing liver problems), psychotic symptoms, or nerve problems. These are rare side effects. But if you have existing liver problems, let your provider know before starting disulfiram. And if you experience hallucinations or delusions, tingling in your arms or legs, or if you have any vision changes, contact your provider immediately.

4. Topiramate

Topiramate (Topamax) is medication that’s FDA approved to treat seizures and prevent migraines. It’s also used off-label for other medical conditions, including AUD. Though it’s not FDA approved for AUD, studies have suggested that it may have potential. In fact, the APA recommends it as an option for moderate-to-severe AUD in some people, including those who haven’t had success with naltrexone or acamprosate.

How it works

Topiramate is thought to balance chemicals in the brain. This includes decreasing dopamine levels. The overall effect is reduced cravings and withdrawal symptoms.

How to take it

Topiramate comes as a tablet and sprinkle capsule. Your healthcare provider may start you at a lower dose of 25 mg per day and increase your dose over several weeks. Doses of up to 150 mg twice daily may be used. But higher doses may be associated with more side effects.

It’s best to avoid drinking alcohol when starting topiramate. But it’s also been shown to be safe and effective in people who are still actively drinking as a way to help them reduce drinking.

Effectiveness

A review of over seven studies found that topiramate was effective in treating AUD. It was shown to reduce heavy drinking and promote abstinence. But it didn’t have an effect on reducing cravings. Most of the studies in this review treated people for 3 months and used a dose of 300 mg per day of topiramate. Another study of over 350 people found that when topiramate was taken for 14 weeks, it reduced heavy drinking days compared to placebo.

When compared to naltrexone in over 150 men, there was no difference between topiramate and naltrexone in treating AUD. But interestingly enough, naltrexone wasn’t better than placebo, whereas topiramate was better than placebo in treating AUD.

Topiramate has also been compared to disulfiram. In a study of 100 men, disulfiram was more likely to lead to continued abstinence, but topiramate was better at reducing cravings.

Topiramate hasn’t been directly compared to acamprosate.

Side effects

Topiramate can cause common side effects, including:

• “Pins and needles” sensation in the hands and feet

• Nausea and vomiting

• Headache

• Dizziness

• Drowsiness

• Changes in taste

• Lack of appetite and weight loss

• Trouble with focus or memory

• Eye-related side effects like blurred vision or double vision.

Topiramate can also cause more serious side effects. These include:

• Reduced sweating lead to overheating

• More serious eye problems like glaucoma

• High levels of acid in the blood called metabolic acidosis

• Suicidal thoughts or behaviors

• Serious birth defects in an unborn baby if taken by a pregnant woman

• Serious skin reactions

5. Gabapentin

Gabapentin (Neurontin) is FDA approved to treat epilepsy and a type of nerve pain caused by shingles (postherpetic neuralgia).

Like topiramate, it’s not FDA approved for AUD. But studies have suggested that it may help people reduce drinking and help people maintain abstinence. Although it’s used off-label for AUD, the APA recommends it as an option for moderate-to-severe AUD in some people. This includes those who haven’t had success with naltrexone or acamprosate.

How it works

Gabapentin may work in a variety of ways to treat AUD. It’s structurally similar to a chemical in the brain called gamma-aminobutyric acid (GABA). GABA helps lower the activity of your nerves. During periods of alcohol withdrawal, the brain has less GABA and becomes stressed. This can lead to alcohol withdrawal symptoms like cravings, mood changes, and worsening sleep.

Gabapentin can help improve symptoms of alcohol withdrawal and normalize brain function even after the withdrawal period. This may help prevent relapse.

How to take it

Studies have used a variety of gabapentin doses to treat AUD. Doses between 900 mg to 1800 mg per day have been effective in some studies.

Effectiveness

Research shows that gabapentin may improve withdrawal symptoms, reduce heavy drinking and promote abstinence when compared to placebo. Higher doses (1800 mg per day) may be more beneficial.

A combination of gabapentin and naltrexone may be better at preventing heavy drinking compared to naltrexone alone. But once gabapentin was stopped, the effect didn’t continue.

Of note, some research suggests that gabapentin is most effective in those experiencing a lot of alcohol withdrawal symptoms.

Side effects

In studies, people taking gabapentin for AUD experienced:

• Drowsiness

• Headache

• Insomnia

• Muscle aches

• Gastrointestinal problems like nausea

• Dizziness

These side effects may improve once your body gets used to the medication. But more serious risks may also occur. If you experience any of these effects, seek emergency care. These include:

• Potential for misuse and addiction

• Trouble breathing when combined with certain medications like opioids and benzodiazepines

• Increased suicidal thoughts or behavior

• Severe allergic reactions

• Extreme dizziness or drowsiness that can lead to falls or an inability to drive

• Seizures if stopped abruptly