A variety of medications are used to treat alcohol use disorder that work in different ways.
- Reduce the desire for alcohol and lessen its pleasurable effects
- Curb cravings
- Reduce anxiety and stabilize mood
Do they work?
People who haven’t been able to stop drinking using other approaches may be helped by adding medication treatment. This includes helping people who are actively drinking or those who have recently stopped but are having cravings, anxiety or relapses.
It’s important to remember that an individual may respond better to one type of medication than another.
Three oral medications (naltrexone, acamprosate, and disulfiram) and one injectable medication (extended-release injectable naltrexone) are approved for treating alcohol dependence. Topiramate, an oral medication used to treat epilepsy and migraine, has also been shown to be effective, although it is not yet approved by the FDA for this use.
BACLOFEN (Lioresal or Gablofen®)
What it does: This muscle relaxant has also been used to decrease anxiety and reduce alcohol cravings.
How it works: Increases GABA in the brain, a natural chemical that has a relaxing effect.
Side effects: Drowsiness, dizziness, weakness, upset stomach, confusion, depression
For a more complete list of side effects click here.
* There are concerns about the safety of baclofen for alcohol use disorder, especially at high doses, with higher risks of hospitalization and mortality than other approved drugs. Chaignot 2018
Availability – Physician prescription
Research Studies
Research Studies
A study of baclofen in 320 patients showed it reduced alcohol intake by 57%. Baclofen was more effective than placebo in reducing drinking to low‐risk levels. Over 12 months, alcohol consumption was 11 grams less per day in people taking baclofen and the number of days without drinking was 3.3. Rigal 2019
Thirteen studies were reviewed on the effect of baclofen for alcohol use disorder. A low dose of 30-60 mg was compared to a high dose of over 60 mg a day. Baclofen worked better in heavy drinkers and the low dose was more effective and caused fewer side effects. Pierce 2018
Baclofen has been shown to promote abstinence but it shows mixed results on other outcomes such as reducing heavy drinking. The use of baclofen as well as the best dosage continues to be debated. Burnette 2022
Even though some results from randomized controlled trials are promising, current evidence remains uncertain on the use of baclofen as a first-line treatment for people with alcohol use disorder. Minozzi 2018
More information on Baclofen
CAMPRAL (Acamprosate)
What it does: Reduces alcohol cravings and withdrawal symptoms after you have quit. It is not effective if you are drinking when you start taking the drug or are using other substances.
How it works: Lessens the unpleasant feelings of withdrawal by working on chemical imbalances in the brain caused by alcohol use.
Side effects: Diarrhea, gas, headaches, insomnia, upset stomach, loss of appetite, dry mouth, dizziness.
For a more complete list of side effects click here.
Availability: Physician prescription
Research Studies
Research Studies
A recent review of 24 studies with 6,915 people showed that acamprosate was a safe and effective treatment. It supports abstinence after alcohol detox. When added to other treatments such as counseling, psychotherapy and peer support groups, acamprosate reduced the risk of returning to drinking. The total time in abstinence was clearly increased. Rösner S 2010
Two other reviews confirm the effectiveness of acamprosate in alcohol dependent patients.
Acamprosate had a significantly larger effect size than naltrexone in maintaining abstinence. Naltrexone had a larger effect size than acamprosate on the reduction of heavy drinking and craving. Maisel NC 2013
Acamprosate and oral naltrexone have the best evidence for treating alcohol-use disorder. Studies have not consistently shown one medication to be better than the other. Because of this, other factors may guide the choice of medication, such as how often it needs to be taken, potential side effects and adverse events, other symptoms you may have, and the availability of treatments. Jonas DE, 2014
More information on Acamprosate
CHANTIX (Varenicline)
What it does: Helps people quit smoking, but recently found to help heavy drinkers reduce the number of alcoholic drinks they consume.
How it works: Blocks the pleasant effects of alcohol on the brain.
Side effects: Nausea, vomiting, gas, heartburn, vomiting, headache.
For a more complete list of side effects click here.
Availability: Physician prescription
*Please note: The FDA has reported that a connection between Chantix and serious psychiatric problems including depression, agitation and suicidal behavior is "increasingly likely." A report from The Institute for Safe Medication Practices also linked Chantix to a variety of health and safety problems. These include accidents and falls, heart rhythm disturbances, heart attacks, seizures, diabetes and various psychiatric disturbances.
Research Studies
Research Studies
A 2013 study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that varenicline (Chantix) significantly reduced alcohol use and craving in people who are alcohol-dependent. Two hundred men and women with alcohol dependence were studied at 5 clinical sites. Varenicline 2 mg a day was taken during weeks 2 to 13. It significantly reduced alcohol use and craving, making it a potentially useful option for the treatment of alcohol dependence. Litten RZ 2013
In a systematic review of 9 studies with 585 people varenicline decreased alcohol consumption and may be an option for decreasing heavy drinking days in people with alcohol use disorder. Oon-arom 2019
DISULFIRAM (Antabuse)
What it does: Antabuse has been used since 1951. Studies show it reduces the craving for alcohol and the risk of relapse.
How it works: Causes unpleasant effects if you drink even small amounts of alcohol while taking it, such as flushing, headache, nausea and vomiting, and anxiety. These effects begin about 10 minutes after you drink alcohol and last for 1-2 hours. It is slowly excreted from the body over 2 weeks.
Side effects: Skin rash, headache, drowsiness, weakness, upset stomach, tiredness.
For a more complete list of side effects click here.
Availability: Physician prescription
Research Studies
Research Studies
In a large review, six of eleven studies showed significant abstinence in people treated with disulfiram, leading to a longer time before relapse and fewer drinking days. Jørgensen CH 2011
Taking Disulfiram helped people continue outpatient treatment and stay alcohol-free longer. It worked best in those with long-term alcohol dependence. For people with alcohol use disorder for a shorter period of time, the combination of disulfiram and acamprosate increased the chances of a successful outcome. Supervised disulfiram treatment is an important component of treatment for alcohol use disorder. Diehl A 2020
More information on Disulfiram
GABAPENTIN (Neurontin)
What it does: Gabapentin is an FDA-approved medication for controlling seizures and relieving nerve pain. It has also been found to curb cravings for alcohol. In 2018 The American Psychiatric Association recommended its use in people with moderate to severe alcohol use disorder, but usually after trying naltrexone and acamprosate first.
How it Works: It reduces alcohol cravings and withdrawal symptoms such as insomnia, sadness and anxiety. It may help increase the number of alcohol-free days.
Side Effects: drowsiness, dizziness, headache, anxiety, constipation
For a complete list of side effects click here.
Availability: Physician prescription
Research Studies
Research Studies
In this 12-week study 150 men and women with alcohol dependence were given gabapentin (either 900 mg or 1800 mg a day) or placebo (a fake pill). Gabapentin increased abstinence rates (17%) and decreased rates of heavy drinking (44.7%) in people who took the 1800 mg a day. This dosage was particularly effective in treating alcohol dependence and symptoms related to relapse including insomnia, sadness, anxiety and craving. Mason BJ 2014
Gabapentin up to 1200 mg a day was found to be most effective in people with alcohol use disorder and a history of alcohol withdrawal symptoms. It significantly increased the number of people with total abstinence and reduced drinking. This effect was strongest in those with greater alcohol withdrawal symptoms before treatment —41% of participants with high alcohol withdrawal symptoms had total abstinence on gabapentin. Anton 2020
NALTREXONE
What it does: Reduces the pleasurable effects of alcohol and the number of cravings, drinks per day and relapse rates. It may help you drink less or stop drinking completely.
How it works: It blocks the parts of your brain that feel pleasure from alcohol so you feel less need to drink and may be able to stop more easily.
Side effects: Nausea, headache, constipation, dizziness, anxiety and insomnia.
For a more complete list of side effects click here.
Of note: Naltrexone should not be used if you have acute hepatitis or liver failure, and should be “carefully considered” in patients with acute liver disease.
Availability: Physician prescription
Research Studies
Research Studies
Naltrexone improves outcomes in people with alcohol use disorder when combined with treatments such as support groups like AA, addiction counseling, family therapy, group therapy, and hospital or residential treatment. But taking daily doses is often a problem for people. Long-acting naltrexone injections may help with this issue.
In large research reviews both Naltrexone and Acamprosate were found to be effective. Acamprosate was more helpful in maintaining abstinence, and naltrexone was more effective in reducing heavy drinking and craving. Maisel NC 2013
Oral naltrexone and acamprosate have the best evidence for helping people with alcohol use disorder. They decrease drinking and increase abstinence rates. Since both are effective other factors may guide which to use - such as how often it needs to be taken, side effects, potential adverse events, other symptoms you may have, and the availability of treatments. Jonas DE 2014
More information on Naltrexone
ONDANSETRON (Zofran)
What it does: Ondansetron is used to treat nausea and vomiting caused by certain cancer therapies. But it has also been found to stop cravings, decrease alcohol use and increase abstinence if you developed an alcohol use disorder before the age of 25 (called early-onset alcohol dependence).
How it works: It acts on two natural brain chemicals, serotonin and dopamine, to reduce alcohol craving and use.
Side effects: Diarrhea, headache, constipation, weakness, dizziness, tiredness.
For a more complete list of side effects click here.
Availability: Physician prescription
Research Studies
Research Studies
A total of 271 people with alcohol use disorder were treated with ondansetron in 3 different doses for 11 weeks. Those with early-onset alcoholism had fewer drinks per day. Ondansetron, 4 microg/kg twice a day, increased the percentage of days abstinent per week and was effective in treating patients with early-onset alcoholism. Johnson BA 2000
People with a certain genetic make up had fewer drinks per day and a higher percentage of days without drinking when taking ondansetron. In these people, ondansetron may be used to treat severe drinking and improve abstinence. Johnson BA 2011
More information on Ondansetron
TOPIRIMATE (Topomax)
What it does: Helps people stop drinking and feel more stable and less anxious - which lessens alcohol cravings and the risk of relapse.
How it works: Reduces levels of the natural brain chemical dopamine which makes drinking less pleasurable. Importantly, it appears to be effective if you are drinking at the time of starting the medication.
Side effects: Numbness and tingling in the hands and feet, difficulty concentrating, confusion, nervousness, headache, drowsiness and mood swings.
Special Alert: The FDA notified healthcare providers and patients of an increased risk of cleft lip and/or cleft palate in infants exposed to a higher dose of topiramate during the first trimester of pregnancy.
For a more complete list of side effects click here.
Availability: Physician prescription
Research Studies
Research Studies
This review on topiramate suggests it is an effective treatment option in alcohol use disorder (AUD), especially in reducing harmful drinking patterns. Though not currently approved by the FDA for this use, topiramate should be considered a good medication for treating AUD. Manhapra A 2019. Manhapra A 2019
Topiramate is an anticonvulsant drug increasingly used for alcohol withdrawal and for outpatient treatment of alcohol dependence. It appears to strongly reduce harmful drinking. Gabapentin, another anticonvulsant drug, may also be effective for reducing the risk of relapse. Hammond CJ 2015
Topiramate was more effective than placebo at reducing the percentage of heavy drinking days as well as increasing the number of days of abstinence. Johnson 2007
More information on Topiramate
