Key takeaway
Naltrexone can reduce alcohol's rewarding effects; acamprosate can help stabilize post-acute craving after detox for many candidates. Choice depends on goals, organs, and adherence. Call or text (800) 653-9376 to compare AUD medication options with local clinicians.
Last updated: Wed Oct 07 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
Two of the most-discussed pills for alcohol use disorder are acamprosate (Campral) and naltrexone (Revia orally; Vivitrol as a monthly shot). They are not interchangeable, and neither is Antabuse.
This page is education, not a prescribing decision. Call 911 for severe alcohol withdrawal. Call or text 988 for a crisis.
Quick comparison
| Naltrexone | Acamprosate | |
|---|---|---|
| Main idea | Blunts reinforcing effects of alcohol (opioid-receptor antagonist) | Helps restore balance after detox; often used to support abstinence |
| Common forms | Daily tablet or monthly injection (Vivitrol) | Usually three-times-daily tablets |
| Big watch-outs | Opioid use / future opioid need; liver warnings | Kidney function; adherence to multiple daily doses |
| Antabuse-like sickness if you drink? | No | No |
Disulfiram is the medicine that can create a severe reaction with alcohol. Do not confuse it with either option above.
How clinicians often choose
- Still drinking / wanting help cutting heavy use: naltrexone is frequently discussed first when opioids are not in the picture.
- Already detoxed and guarding abstinence: acamprosate is frequently discussed as maintenance support.
- Opioid pain needs or recent opioid use: naltrexone may be a poor fit until timing is safe.
- Kidney disease: acamprosate may be limited.
- Adherence struggles: monthly injectable naltrexone can beat daily pills for some people.
Counseling, mutual-help, and fixing sleep/stress still matter. Medication is one tool.
How to start a comparison conversation
- Tell the clinician your goal: cut back, stop, or prevent relapse after detox.
- List opioids, liver/kidney history, and prior medication trials.
- Ask about side effects, labs, and prior authorization.
- Call or text (800) 653-9376 if you need help finding a prescriber who treats alcohol use disorder:
Calling is free; the referral service is paid for by treatment providers, and we check your benefits before you commit.
See acamprosate for alcohol use disorder and naltrexone / Vivitrol for deeper single-drug pages.
Additional Resources
Sources cited on this page:
- NIAAA - Treatment for Alcohol Problems
- FDA drug labeling (acamprosate, naltrexone)
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Which is better for alcohol use disorder, acamprosate or naltrexone?
Neither wins for everyone. Naltrexone is often considered when reducing heavy-drinking reward is the goal. Acamprosate is often considered after detox when the goal is maintaining abstinence and reducing protracted craving.
Can I take acamprosate and naltrexone together?
Some clinicians combine them in selected cases. That decision needs a prescriber who knows your liver, kidney, and opioid status.
Does naltrexone make you sick if you drink like Antabuse?
No. Naltrexone is not disulfiram. It does not create an Antabuse-style alcohol-sickness reaction.
Who should avoid naltrexone?
People who need opioids for pain, who are not opioid-free yet, or who have significant liver concerns may not be good candidates until a clinician reviews labs and goals.
Who should avoid acamprosate?
Severe kidney impairment is a common reason clinicians avoid or adjust acamprosate. Always confirm with the prescribing clinician.