Which Medications Are Used To Stop Alcohol Cravings?

There’s no denying it: scaling back on alcohol use, or eliminating it entirely, is no easy feat. Especially for those of us who have developed regular drinking habits or come to depend on alcohol for easing physical or emotional discomfort, breaking free from this toxic substance can be challenging. 

Thankfully, many tools and treatment options can help us reduce — or quit — drinking. What we might not realize, however, is that medication is one of them. In this post, we’ll explore some of the most common medications used to stop drinking.

Alcohol Medication: Pills To Stop Drinking

There are four common alcohol pills, or medications to stop drinking, including naltrexone, acamprosate, disulfiram, and topiramate. Let’s take a closer look at each one of these:

Naltrexone

Also known as Vivitrol, naltrexone is one of the most popular medications for moderate to severe alcohol use disorder (AUD). It’s FDA-approved and works by decreasing alcohol cravings. As an opioid blocker, it blocks the areas of the body where opioids attach, essentially stopping the rewarding effects of alcohol.

A recent study found that naltrexone significantly reduces binge drinking among men with mild to moderate alcohol use disorder. Research also shows that naltrexone works best for people who have already stopped drinking for at least four days when they begin treatment. 

The medication can be taken daily as a pill or monthly as an injection. Healthcare professionals might recommend staying on it for at least one year, as some studies show that when naltrexone is stopped, the benefits are lost. 

As for side effects, some of the most common include nausea and vomiting, appetite changes, headaches, dizziness, and restlessness. More serious side effects include liver damage, depression, and thoughts of self-harm or suicide. For those of us with liver failure or acute hepatitis, it’s important not to take naltrexone. 

Acamprosate

Acamprosate is another popular choice for people with moderate to severe (AUD). It’s FDA-approved and often used instead of naltrexone for people who can’t take naltrexone, such as those of us with liver problems or who use opioids. 

Acamprosate helps rebalance chemicals in the brain that may have been altered by drinking too much. More specifically, it works by interacting with two chemical messenger systems in the brain: GABA (gamma-aminobutyric acid) and glutamate. GABA stifles certain nerve cells and may help control the fear or anxiety we feel when those cells are overexcited. Glutamate, on the other hand, stimulates nerve cells. These systems become imbalanced if we’ve been drinking heavily over time; acamprosate is designed to level them out. 

Several studies have found that acamprosate effectively helps people reduce alcohol use, even after the medication is stopped. The usual dosage is two tablets three times a day. This timing and dosage might make it difficult to take properly, lowering its effectiveness. 

Similar to naltrexone, acamprosate seems to work best if we stop drinking before starting treatment. The medication can cause some side effects, such as diarrhea, trouble sleeping, anxiety, tiredness, depression, and dizziness. For those of us with severe kidney damage, acamprosate might not be a good option.

Disulfiram

Disulfiram, otherwise known as Antabuse, is the oldest FDA-approved medication for alcohol-use disorder. While naltrexone and acamprosate are the most popular medications for reducing drinking, disulfiram might still be a good option for some of us.  

The medication is an alcohol blocker: it prevents alcohol from being broken down, or metabolized, by the liver. If we drink alcohol while taking disulfiram, it causes an unpleasant reaction that helps discourage drinking. For instance, we might experience flushing, nausea, vomiting, difficulty breathing, sweating, low blood pressure, or heart palpitations. These symptoms usually last for about an hour and can happen as late as two weeks after our last dose of disulfiram. 

Research has shown that disulfiram can help people reduce drinking. However, some studies show that it’s more effective when taken under the supervision of a family member, friend, or as part of a program. 

The medication comes in tablet form and is usually taken once in the morning. It can cause various side effects — such as numbness, skin irritation, headache, drowsiness, and sexual dysfunction — but these usually improve or go away after about two weeks. In rare cases, disulfiram can also cause liver damage (especially if we have existing liver problems), psychotic symptoms, or nerve problems. 

Topiramate 

Topiramate is a medication that’s FDA-approved to treat seizures and prevent migraines. However, some doctors also use it to treat alcohol use disorder (AUD), as it helps rebalance chemicals in the brain and correct the electrical activity of brain cells. 

While topiramate is not FDA-approved for alcohol use disorder, studies have suggested that it can be effective in reducing alcohol cravings and withdrawal symptoms. In fact, the American Psychiatric Association recommends it as an option for moderate to severe AUD, including for people who haven’t had success with naltrexone or acamprosate. 

One study of over 350 people found that when topiramate was taken for 14 weeks, it reduced heavy drinking days more than the placebo. Interestingly, another study found that while disulfiram was more likely to lead to continued abstinence, topiramate was better at reducing cravings. 

Topiramate comes as a tablet and sprinkle capsule. It’s generally advised to avoid drinking alcohol when starting the medication, even though it’s been shown to be safe and effective in people who are still actively drinking.

Common side effects include nausea and vomiting, headache, dizziness, drowsiness, “pins and needles” sensations in the hands and feet, changes in taste, and trouble with focus or memory. It can also cause more serious side effects, such as eye problems, skin reactions, suicidal thoughts, or high levels of acid in the blood called metabolic acidosis. 

The Bottom Line

Naltrexone, acamprosate, disulfiram, and topiramate are four common alcohol medications to stop drinking and help curb alcohol cravings. Naltrexone and acamprosate in particular are popular, FDA-approved options that have proven to be effective in helping stop or reduce drinking. However, it’s best to consult a medical professional to determine which medication might be best for you. 

Finally, Reframe is here to help. We’ve enabled millions of people to cut back on their alcohol consumption and enhance their overall health and well-being.