Review of studiesNaltrexone for alcohol2018Landmark study
Palpacuer 2018: five medicines for cutting down on drinking, compared
Palpacuer C, Duprez R, Huneau A, et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate
What it found
In people still drinking when treatment began, naltrexone showed no effect on total alcohol consumption across 32 trials, while nalmefene, topiramate and baclofen (in one study) did better than placebo. The authors found no high-grade evidence for any of the five drugs, and none showed a benefit for health.
- Patients
- 6,036
- Nalmefene vs placebo, total drinking
- SMD = -0.19
- Topiramate vs placebo, total drinking
- SMD = -0.77
- Trials at risk of incomplete outcome data
- 26 studies (81%)
What they tested
A network meta-analysis pools trials and also compares drugs indirectly, through their results against placebo, when no trial tested them head to head. The authors gathered published and unpublished double-blind trials of nalmefene, naltrexone, acamprosate, baclofen and topiramate in adults who were not abstinent, including data obtained from drug companies and regulators.
The main measure was total alcohol consumption. Other drinking measures and health outcomes were secondary.
What they found
No study compared the drugs directly with each other. Against placebo, nalmefene (SMD -0.19), topiramate (SMD -0.77) and baclofen (SMD -1.00, one study) reduced total alcohol consumption. An SMD is a standard way to size an effect, and a more negative number means a bigger drop.
No efficacy was observed for naltrexone or acamprosate. Other drinking measures gave similar results, except that baclofen's benefit wasn't reproduced.
More people dropped out for safety reasons on nalmefene and naltrexone. No treatment showed any reduction in harm, though no study was powered to test health outcomes.
Risk of bias was high: 26 studies (81%) had a risk of incomplete outcome data and 17 (53%) a risk of selective reporting. Indirect comparisons suggested topiramate cut drinking more than nalmefene, naltrexone and acamprosate, though the authors note its safety profile is known to be poor.
Limits
- It covered only people who were still drinking at the start, and it pooled daily and as-needed (targeted) naltrexone trials together, so it doesn't settle the question for any one way of taking naltrexone.
- Many of the included trials had a high risk of bias, and none was designed to measure health outcomes.
- Comparisons between drugs were all indirect, since no trial tested them against each other.
What it means if you're considering naltrexone
For someone hoping to use naltrexone to drink less, not quit, this review is sobering: pooled across trials in people still drinking, naltrexone didn't reduce total drinking compared with placebo. Because it mixed daily and targeted trials, it doesn't settle the case for the Sinclair Method, but it does undercut claims of a dramatic effect.
Frequently asked questions
Does naltrexone help you drink less if you keep drinking?
In this 2018 review of trials in people who were still drinking, naltrexone showed no effect on total alcohol consumption compared with placebo. The authors found no high-grade evidence for any of the five drugs studied.
Is nalmefene better than naltrexone for cutting down?
No trial compared them directly. Against placebo, nalmefene reduced total drinking (SMD -0.19) and naltrexone showed no effect, but both had more dropouts for safety reasons.
The paper
Palpacuer C, Duprez R, Huneau A, et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction. 2018;113(2):220-237. doi:10.1111/add.13974
Read the reviewdoi:10.1111/add.13974
We wrote this page from the paper's published abstract, and the study's numbers here come from there. Updated October 17, 2026.
Medical disclaimer
This page is for information only and is not medical advice, diagnosis, or treatment. Don't start, stop, or change any medicine — including naltrexone — without your prescriber. Naltrexone must not be used by people taking opioid pain medicines, people dependent on opioids, or people in opioid withdrawal (FDA label). In an emergency call 911; for crisis support call or text 988. Full medical disclaimer.