Medication for Alcoholism: Disulfiram, Naltrexone, Acamprosate & More
Last Updated: September 22, 2023
Alcohol addiction can be difficult to manage on your own. When you struggle with alcohol, the physical and psychological cravings to drink often keep you in a cycle of alcohol use. Fortunately, medications, therapy and support can help you recover from alcoholism, controlling the side effects and symptoms that could lead to relapse.
In this article, we will discuss some of the most common medications to help you stop — and stay away from — alcohol.
Quick Facts on Medication for Alcoholism
- Prescription medications like naltrexone and acamprosate can help you stay sober after you stop drinking.
- Medically supervised detox can help ease alcohol withdrawal symptoms using medications like diazepam, lorazepam and chlordiazepoxide.
- Taking medications to treat alcoholism during your recovery can be safer and lower your chances of relapse.
Medication for Managing Alcohol Consumption
Staying sober after you’ve quit drinking can be a challenge, and many methods are often used at the same time to increase your success. Medically-assisted detox and rehab can wean you off of alcohol and start to teach you the skills to live an alcohol-free life. However, medication therapy can also help decrease the pleasurable feelings your brain links to alcohol, making it easier to stay away from drinking.
Some of the most common medications prescribed to help you stay sober are:
Naltrexone (ReVia, Vivitrol)
Naltrexone is a gold-standard medication for helping a person stay sober from alcohol and can help prevent alcohol cravings. Naltrexone works by blocking opioid receptors in the brain which play a key role in alcoholism and would otherwise cause alcohol’s pleasurable effects.
Naltrexone comes as both a monthly 280mg long-acting injection and a once-daily oral 50mg tablet. Generally, experts prefer the injectable form of the drug as this can improve adherence to the regimen, although the injection requires a monthly doctor’s office visit.
Naltrexone’s side effects include:
- Nausea or vomiting
- Anxiety or nervousness
- Trouble sleeping
- Injection site reaction (for the injectable form of the drug)
One downside to taking naltrexone is that because the medication is an opioid blocker, it can interfere with treatment if the person needs to be on an opioid painkiller.
Like naltrexone, acamprosate is also a first-line medication to help a person stay sober from alcohol. Experts aren’t sure exactly how the drug works but know that it has an effect on the neurotransmitter glutamate.
Acamprosate is usually prescribed at an oral 666mg tablet dose three times per day. Those who take acamprosate are less likely to relapse into drinking and are likely to drink for fewer total days compared to people not on the drug. However, in part due to the burden of remembering to take a medication three times a day, many people have problems taking acamprosate exactly as prescribed.
Acamprosate is generally well-tolerated, with its main side effects limited to diarrhea and weakness.
Disulfiram is a medication that is sometimes prescribed when naltrexone or acamprosate cannot be used. The drug works by interfering with the breakdown of alcohol after you’ve had a drink, leading to a buildup of a chemical called acetaldehyde, which can make you feel sick if you drink alcohol or use products that contain alcohol, like certain cough medicines or hand sanitizers. This can give people extra motivation to stay away from alcohol.
A disulfiram-alcohol reaction can be a serious medical emergency in severe cases and can even be deadly. Symptoms of a disulfiram reaction with alcohol include:
- Headache or neck ache
- Breathing problems
- Nausea and vomiting
- Chest pain
- Fast heartbeat
- Low blood pressure
- Blurred vision
- Passing out
Disulfiram should be given orally once daily and comes in tablet strengths of 250mg and 500mg. The drug should not be started until someone has been alcohol-free for at least 12 hours, and alcohol should be avoided for the next 14 days.
Disulfiram’s side effects include:
- Liver problems
- Skin rashes or outbreaks
- Impotence in men
- Metallic or garlic-like aftertaste
- Nerve damage
Topiramate is sometimes prescribed for alcohol use disorder if the person cannot take naltrexone or acamprosate. Studies have shown that the drug can reduce the number of total and heavy drinking days.
Topiramate is generally prescribed for alcoholism at a starting dose of 25mg daily, gradually increasing to 200–300mg. One benefit of topiramate is that you do not necessarily need to stop drinking before taking the medication.
Topiramate’s side effects include:
- Pins and needles sensation
- Itchy skin
- Taste changes
- Appetite loss
- Trouble sleeping
- Concentration and attention problems
- Poor memory
Baclofen is rarely used to treat alcohol use disorder, with experts noting that it has shown no benefit in multiple studies. As a result, baclofen is often avoided in favor of medications with better evidence, like naltrexone or acamprosate.
When it is used, baclofen is usually given as an oral tablet three times daily, although no specific dose recommendations exist due to limited data. Side effects include:
Medication for Managing Alcohol Withdrawal
Symptoms of alcohol withdrawal can occur when you first quit drinking as your body adjusts to the lack of alcohol. Because alcohol withdrawal can be dangerous and even fatal in some cases, it is safest to undergo withdrawal under the care of a medical professional, like in a medically supervised detox center. While you are medically supervised, your doctor can prescribe medications to ease your withdrawal symptoms and prevent dangerous complications like seizures.
Benzodiazepine drugs are usually considered first-line therapy for alcohol withdrawal, with three of the most commonly used being:
Benzodiazepines have similar side effects, including:
- Slowed breathing
- Passing out
- Nausea or vomiting
Diazepam is one of the drugs of choice for severe alcohol withdrawal syndrome due to its quick onset and long duration. Its long duration helps prevent rebound withdrawal symptoms, making withdrawal easier. Diazepam is also recommended right after an alcohol withdrawal seizure has occurred.
Diazepam doses may differ based on your symptoms, but one regimen is diazepam 5–10mg every six hours for up to eight total doses, then as needed.
Along with diazepam, chlordiazepoxide is a drug of choice for severe alcohol withdrawal due in part to its long duration of action, which helps prevent rebound symptoms.
Chlordiazepoxide dosing regimens can differ, but one option is chlordiazepoxide 25–50mg every six hours for up to eight total doses, then as needed.
Lorazepam is a drug that is often prescribed for alcohol withdrawal symptoms due to its quick onset. Experts specifically recommend lorazepam or diazepam when seizures have occurred.
Although lorazepam dosing regimens can differ, one option is lorazepam 1–2mg every six hours for up to eight total doses, then as needed.
Other Medications for Alcohol Withdrawal
Alcohol withdrawal and detox may trigger uncomfortable symptoms, some of which can be life-threatening. Delirium tremens or DTs, for example, can cause:
- Uncontrollable shaking
- High blood pressure
When benzodiazepines cannot be used or are ineffective, other medications are sometimes prescribed as replacement or add-on treatments. These may include:
- Valproic acid
Medication and Other Treatment for Alcoholism
Medications can help you get through the most difficult stages of withdrawal and recovery. That means your chances of long-term sobriety have never been better. Your doctor may even prescribe vitamin supplements to improve your overall health.
Programs for alcohol addiction recovery in Florida address a wide range of physical and psychological needs. Because no two people are alike, your program should also be uniquely yours. Contact us today to learn more about admissions for a healthier, sober life.
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