Medication to Stop Drinking

The options at a glance

Three medicines are FDA-approved for alcohol use disorder

All three need a prescription. NIAAA describes them as neither addicting nor complicated to prescribe.¹

Naltrexone blocks part of the reward from drinking

Naltrexone blocks opioid receptors in the brain involved in the rewarding effects of alcohol. It comes as a daily pill or a monthly injection, and the pill can be started while someone is still drinking.¹ It causes no sickness reaction if you drink; what drinking on it is like is covered on drinking on naltrexone. The main danger is opioids. Anyone with opioids in their system can go into sudden, severe withdrawal, so the label asks for at least 7 to 10 days off short-acting opioids first.¹¹ The full list is on what to avoid on naltrexone.

The monthly shot, Vivitrol, is for people who can stop drinking before the first injection. Taking naltrexone tablets beforehand is not required.¹² Trial-by-trial results are on does naltrexone work?

Acamprosate is for staying stopped

Acamprosate is approved to help people keep from drinking once they have stopped, and it is started as soon as possible after withdrawal ends. The dose is two 333 mg tablets three times a day, and treatment continues if the person drinks again.⁴ It is ruled out with severe kidney disease (creatinine clearance of 30 mL/min or less) and needs a lower dose with moderate kidney disease.⁴ Because the liver does not clear it, the VA/DoD guideline says it may be considered for people who take prescribed opioids or have significant liver damage.¹⁵ The head-to-head comparison is on naltrexone vs acamprosate.

Disulfiram makes drinking an unpleasant risk

Disulfiram blocks the breakdown of alcohol, so a drink causes flushing, nausea and other symptoms.¹ It must never be given to someone who is intoxicated or who doesn't know they are taking it, and not until at least 12 hours after the last drink.⁵ In a meta-analysis of 22 trials, it beat comparison groups only when patients knew they were taking it, and did best when someone watched each dose.¹⁴ Both guidelines limit it to people aiming not to drink at all.^15,17 Reactions, liver risks and the trial details are on naltrexone vs disulfiram.

Europe has one more option. The European Union authorised nalmefene, sold as Selincro, in 2013 to help adults with alcohol dependence who drink heavily cut down. None of the FDA's nalmefene approvals covers alcohol.^18,19

The best-studied pills help 1 extra person in every 11 to 18 treated

A number needed to treat (NNT) is how many people must take a medicine instead of a placebo for 1 more person to benefit. The 2023 review for the federal Agency for Healthcare Research and Quality (AHRQ) pooled 118 trials with 20,976 people and calculated NNTs only for medicines with at least moderate-strength evidence.³

So of 11 people who take naltrexone, about 1 avoids heavy drinking who would not have on placebo; the rest either would have done well anyway or were not helped. The wide intervals mean the true benefit could be noticeably larger or smaller.³

Topiramate had moderate-strength evidence for fewer drinking days, fewer heavy drinking days and fewer drinks per drinking day, but those outcomes do not yield an NNT. Gabapentin and baclofen had low-strength evidence, and disulfiram was not supported by well-controlled trials.² If one medicine doesn't work, NIAAA advises that trying another often helps.¹

Topiramate and gabapentin are prescribed off-label

Neither is FDA-approved for alcohol use disorder. Topiramate is labelled for epilepsy and migraine prevention, and gabapentin for epilepsy and nerve pain after shingles.^6,7 A 2018 JAMA review notes that randomized trials show some drugs approved for other conditions, such as topiramate, work for alcohol use disorder.²⁰

Topiramate. In a 14-week US trial of 371 adults with alcohol dependence, people on topiramate (up to 300 mg a day) cut their share of heavy drinking days by 8.44 percentage points more than placebo, counting everyone who dropped out as having relapsed. Side effects were common: tingling or numbness in 50.8% vs 10.6% on placebo, taste changes in 23.0% vs 4.8%, and trouble concentrating in 14.8% vs 3.2%.¹³ The VA/DoD guideline adds dizziness, thinking problems and weight loss, and notes that raising the dose may take several visits.¹⁵ The label warns that topiramate can harm a developing baby, including cleft lip and palate.⁶ It also says, "You should not drink alcohol while taking TOPAMAX," which is a point to raise with a prescriber if your goal is cutting down.⁶

Gabapentin. In a 12-week trial of 150 adults at one research clinic, all of whom got counseling, 17.0% on 1,800 mg a day stayed fully abstinent, against 11.1% on 900 mg and 4.1% on placebo. For no heavy drinking, the figures were 44.7%, 29.6% and 22.5%. At 1,800 mg the NNT was 8 for abstinence and 5 for no heavy drinking.²¹ Only 85 of the 150 finished the study, and the VA/DoD guideline cites the single site and high dropout as reasons for caution.^15,21 The label warns of serious, sometimes fatal breathing problems when gabapentin is taken with opioids or other sedating drugs, and of misuse, mostly in people with a history of polysubstance use.⁷ Gabapentin is not a controlled substance.⁷ Because the kidneys clear it, the VA/DoD guideline sees it as an option with liver disease.¹⁵

Baclofen's trial results are mixed

A 2023 Cochrane review of 17 trials with 1,818 people found that baclofen probably lowers the risk of returning to drinking and raises the share of days without alcohol, mainly in people who had gone through detox first. It did not reduce heavy drinking days or craving, and it increased tiredness, dizziness and sleepiness.¹⁶ In the ALPADIR trial, 320 detoxified adults were randomized; at a target dose of 180 mg a day, 11.9% on baclofen and 10.5% on placebo stayed abstinent for 20 weeks, a difference that was not statistically significant.²² The VA/DoD guideline found the evidence too weak to recommend for or against baclofen, and warns that stopping it suddenly can cause hallucinations and seizures.¹⁵

Semaglutide (Ozempic) cut some drinking measures in a 48-person trial

Ozempic is a GLP-1 drug approved for type 2 diabetes, not for alcohol use disorder.^1,8 In a 2025 trial of 48 adults with alcohol use disorder who were not seeking treatment, 9 weeks of low-dose semaglutide cut drinks per drinking day and craving but did not change average drinks per day or drinking days; the authors call this initial evidence that justifies larger trials.⁹ Naltrexone, which blocks opioid receptors instead, is also one of the two drugs in the weight-management pill Contrave.^1,23

Medication for alcohol cravings: what the trials measured

Several medicines lowered craving in trials, but lower craving did not always mean less drinking.

• Naltrexone. The VA/DoD guideline lists less craving among its benefits.¹⁵
• Acamprosate. NIAAA describes it as easing the anxiety, restlessness, low mood and poor sleep that can follow stopping.¹
• Gabapentin. Craving, mood and sleep improved with dose in the 150-person trial.²¹ A later multisite trial of an extended-release form found no difference in craving.¹⁵
• Baclofen. Craving fell in ALPADIR, but not across the 17 trials pooled by Cochrane.^16,22
• Semaglutide. Weekly craving fell in the 48-person trial.⁹

Disulfiram works another way, through the expectation of a reaction.¹⁵

Questions to ask before choosing

• Do I want to stop completely, or cut down? The APA recommendation for naltrexone and acamprosate covers either goal; disulfiram is for people aiming to stop.¹⁷
• Do I take opioids or might I need them? The APA advises against naltrexone for anyone who uses opioids or expects to need them.¹⁷
• How are my liver and kidneys? The APA advises against naltrexone in acute hepatitis or liver failure and against acamprosate with severe kidney impairment.¹⁷
• Could I be pregnant, or am I breastfeeding? The APA recommends against these medicines in pregnancy or breastfeeding unless they treat withdrawal or another condition.¹⁷
• Will I take pills several times a day? Acamprosate is taken three times a day; the VA/DoD suggests the naltrexone shot when taking medicine reliably is a concern.^4,15

Naltrexone and acamprosate do not reduce alcohol withdrawal symptoms.^4,12 If you drink heavily every day, plan how to stop with a clinician; see withdrawal and other checks before starting.

The labels for naltrexone, acamprosate, topiramate and gabapentin all ask that patients be watched for depression or suicidal thoughts.^4,6,7,11 If you have thoughts of suicide, call or text 988.²⁴

Few people with alcohol use disorder are offered a medicine

In 2024, 2.5% of people in the US aged 12 and older with alcohol use disorder (about 697,000 of an estimated 28.0 million) received medication for it.^10,25 Primary care clinicians can offer these medicines along with brief counseling.¹

Generic naltrexone, acamprosate, disulfiram, topiramate and gabapentin are all low-cost.¹⁵ In 2023 Medicaid data from SAMHSA, acamprosate and disulfiram had the lowest Medicaid coverage rates of the alcohol and opioid medicines.²⁶ What the online programs charge is on naltrexone cost.

Share your experience

Have you tried a medicine to stop or cut down drinking? Tell us what happened, or read other people's naltrexone reviews.

How we checked

• Sources: the current DailyMed labels for each medicine (Topamax March 2026, Neurontin May 2026, Ozempic June 2026); the APA (2018) and VA/DoD (2021) guidelines; the 2023 AHRQ review and its JAMA version; the 2023 Cochrane baclofen review; trial abstracts on PubMed; NIAAA pages.^{2,3,6,7,15-17}
• Each figure was checked against our saved copy on October 17, 2026. Trials were read as abstracts.

Getting treatment

To compare online programs that prescribe naltrexone for alcohol, see where to get naltrexone online. For a clinic, a therapist or a non-naltrexone medicine, the NIAAA Alcohol Treatment Navigator has no commercial sponsors, and SAMHSA runs FindTreatment.gov.^28,29