Naltrexone and acamprosate are both FDA-approved medications used in care for alcohol use disorder. They work differently, are dosed differently, and suit different situations. A licensed clinician chooses between them, or recommends another option, based on an individual assessment. This article is a general-education comparison, not a ranking of one over the other.
How they work
Naltrexone blocks opioid receptors, which is part of how it is used to support people who want to drink less or stop. Acamprosate works on a different system in the brain and is used to help maintain abstinence after a person has stopped drinking. Because the mechanisms differ, the two are suited to different goals and situations.
Dosing cadence
Oral naltrexone is usually taken once a day. Acamprosate is typically taken multiple times a day. Dosing for either is set by a clinician, and acamprosate dosing may be adjusted for people with reduced kidney function.
Who each may suit
Naltrexone is often considered for people who want to cut down or stop and who do not use opioids, since it interferes with opioid medicines. Acamprosate is generally started after a person has already stopped drinking and is focused on maintaining abstinence. Kidney function, opioid use, liver history, other medications, and personal goals all factor into the choice.
A clinician decides
There is no single best medication for everyone. A clinician weighs your health history and goals and may recommend naltrexone, acamprosate, another medication, or a different level of care. For more on naltrexone, see naltrexone side effects: what to know. To see how an online review works, read how telehealth prescribing works.
This overview is educational and does not replace an individual medical assessment. Anyone who may be experiencing severe alcohol withdrawal should seek urgent medical attention.
Common questions
Which one works better? Neither is universally better. They serve different goals, and a clinician chooses based on an individual assessment.
Can they be used together? A clinician decides whether any combination of medications is appropriate. Do not combine medications on your own.
Do they have different timing? Yes. Oral naltrexone is usually once daily; acamprosate is usually taken several times a day.
Sources
- U.S. Food and Drug Administration, drug labeling information: FDA Drugs
- National Institute on Alcohol Abuse and Alcoholism (NIAAA): niaaa.nih.gov