Naltrexone is an opioid antagonist. It binds to opioid receptors, blocking the ability of endogenous opioids released with alcohol consumption to bind and activate the release of dopamine. This reduces the pleasurable effects of alcohol, and can help reduce cravings. Naltrexone does not stop patients from consuming alcohol, nor does it precipitate any physical symptoms when alcohol is consumed while the patient takes naltrexone.

Injectable naltrexone (Vivitrol®)

Vivitrol® is the newest FDA approved medication treatment option for alcohol dependence. Vivitrol® is a long-acting, extended release formulation of naltrexone administered as a single 380 mg intramuscular (IM) injection once a month. Studies have shown that when combined with proper psychosocial therapy, Vivitrol® is much more effective than support alone. As with oral naltrexone, Vivitrol® carries a black box warning for liver injury, although this is very rare. Opioid medications are ineffective for pain management if patient is on Vivitrol®. Patients should carry a Vivitrol® card to inform physicians in case of emergencies requiring pain management.

Oral Naltrexone (Revia®)

Oral naltrexone is recommended for highly motivated patients willing to take tablets every day. The dose is 50 mg tablet once a day. Common side effects include nausea and fatigue. There is a black box warning about liver toxicity requiring blood tests to monitor liver enzymes. Non-compliance with oral naltrexone is a common problem limiting its clinical use.

Disulfiram (Antabuse®)

Disulfiram is an aversion medication therapy that blocks the breakdown of alcohol in the liver resulting in a buildup of acetaldehyde and a toxic reaction 5–30 minutes after drinking alcohol. The “disulfiram-alcohol reaction” includes nausea, vomiting, facial flushing, headache, dizziness, sweating, heart palpitations, and blurred vision; it lasts 30 minutes to a few hours after alcohol use stops. Alcohol and alcohol-containing products should be avoided (e.g., mouthwash, cold medications) while taking and up to two weeks after stopping disulfiram. Patients should be thoroughly educated and carry a medical alert card. Dosage is 250 mg Tablet once/day; patient must be abstinent at least 12 hours from alcohol and alcohol-containing products to begin medication. Side effects are usually minor and transient, but may include drowsiness, fatigue, metallic or garlic aftertaste, skin rash or acne, headaches, and impotence. Very rarely can cause serious liver injury; liver function should be tested prior to and regularly during treatment. A good candidate might be a highly motivated alcoholic with poor impulse control who uses despite multiple treatment episodes.

Acamprosate (Campral®)

Campral® is effective in post withdrawal maintenance of alcohol abstinence. Campral® acts on the GABA and glutamate neurotransmitter systems and is believed to work by reducing symptoms of post acute (protracted) withdrawal, such as insomnia, anxiety, and restlessness. Campral® is an oral medication with a recommended daily dose of two (2) 333mg tablets three times a day. Patients must be abstinent from alcohol before beginning treatment. It is well tolerated and common side effects are diarrhea and abdominal discomfort. Campral® does not stop patients from consuming alcohol, nor does it precipitate any physical symptoms when alcohol is consumed.

Topiramate (Topamax®), ondansetron (Zofran®) and baclofen are other medications that have been found to be effective in alcohol dependence in clinical research.