Substance guides

Naltrexone vs. acamprosate: Which alcohol medication is right for you?

Published March 22, 2025 · 7 min read · Updated April 2026

Reviewed for accuracy by licensed clinical professionals.

Both are FDA-approved for AUD but work through completely different mechanisms and serve different purposes in recovery.

How they differ

Naltrexone blocks opioid receptors, reducing the pleasure from alcohol and decreasing cravings. It can be used while still drinking (Sinclair Method). Acamprosate stabilizes glutamate/GABA balance disrupted by chronic alcohol use, reducing the discomfort of abstinence. It requires abstinence to be effective.

Who benefits from each

Naltrexone: people who want to reduce drinking or achieve abstinence, those with strong cravings. Acamprosate: people who have already achieved abstinence and want to maintain it, those who find sobriety physically uncomfortable.

Practical differences

Naltrexone: 1 pill daily or monthly injection. Acamprosate: 2 pills three times daily (higher pill burden). Neither has abuse potential. Both can be combined with therapy.

Authoritative sources

This article references guidelines from: SAMHSA · NIDA · ASAM

Frequently asked questions

Is naltrexone or acamprosate better?

Neither is universally better. Naltrexone reduces cravings and drinking pleasure. Acamprosate supports abstinence maintenance. Choice depends on individual goals.

Can you take both together?

Yes. Some clinicians prescribe both simultaneously, addressing cravings and abstinence support.

Do these medications cure alcoholism?

No medication cures AUD. These reduce cravings and support sobriety, best combined with therapy.

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.