Addiction medicine
Alcohol-dependence drugs
Acamprosate, naltrexone, disulfiram — Medicines that help people stay off alcohol after stopping — alongside psychological support.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
These medicines support people in staying off alcohol after stopping drinking, as part of a wider package of psychological and social support. They are relapse-prevention treatments, not treatments for the acute withdrawal phase.
How it works
They work in different ways: acamprosate helps restore the brain's chemical balance to reduce craving; naltrexone blocks opioid receptors to reduce the pleasurable "reward" of drinking; and disulfiram blocks alcohol breakdown so that drinking causes a rapid, unpleasant build-up of a toxic by-product — a deterrent effect.
In practice
In practice these drugs are used to maintain abstinence (or reduce drinking) after a person has stopped, and they work best combined with psychological and social support rather than alone — they are not detox or withdrawal treatments in themselves. Each suits a different situation. Acamprosate reduces craving and is generally well tolerated. Naltrexone, an opioid blocker, dampens the reward from alcohol — but it must not be used in anyone needing opioid painkillers, and it precipitates withdrawal in opioid-dependent people, so a drug history is essential. Disulfiram is a deterrent: it causes a deliberately unpleasant reaction (flushing, palpitations, vomiting) if alcohol is taken, which means careful patient selection, supervision and clear warnings about hidden alcohol in everyday products. Liver function is relevant across the group, and motivation and support determine success more than the drug choice.
Examples
Practical use
How to take it & use it well
- Acamprosate, naltrexone and disulfiram are used to help prevent relapse and are most effective alongside counselling and support.
- Acamprosate is usually taken as tablets spread through the day to help reduce cravings after you have stopped drinking.
- Naltrexone is taken by mouth to reduce the reward from alcohol; you must not take it if you need opioid painkillers, as it blocks them.
- Disulfiram is taken as a deterrent; if you drink any alcohol while on it, you can become very unwell, so total avoidance of alcohol is essential.
- Avoid all hidden sources of alcohol on disulfiram, including some mouthwashes, perfumes, foods and over-the-counter medicines.
- Keep your appointments, as monitoring and ongoing support improve the chance of staying well.
Common uses
- Maintaining abstinence after alcohol detoxification
- Reducing relapse with psychosocial support
- Reducing heavy drinking (nalmefene, selected patients)
Monitoring
- Drinking outcomes and engagement with support
- Liver function where indicated
- Opioid use (naltrexone) and adherence/supervision (disulfiram)
Weighing it up
Advantages & disadvantages
Advantages
- Can improve the chances of staying abstinent or cutting down when combined with psychological support.
- Different options allow treatment to be matched to your situation and preferences.
- Acamprosate and naltrexone can reduce cravings or the reward from drinking.
- Disulfiram provides a strong deterrent for people who are motivated to avoid alcohol completely.
Disadvantages
- Disulfiram causes a very unpleasant and potentially dangerous reaction if any alcohol is taken.
- Naltrexone blocks opioid painkillers and can precipitate withdrawal in anyone dependent on opioids.
- Side effects can include nausea, diarrhoea, headache or low mood.
- These medicines support recovery but do not replace counselling and behaviour change.
- Liver function may need monitoring with some of these treatments.
Key safety principles
What to watch for
- Naltrexone blocks opioids — do not use with opioid painkillers and beware precipitated withdrawal; take a careful drug history.
- Disulfiram causes a severe reaction with any alcohol (including hidden sources) — needs selection, supervision and clear warnings.
- Check liver function; these support, but do not replace, psychological and social treatment.
Key interactions
What to avoid or check alongside
- Disulfiram with alcohol from any source causes flushing, palpitations, severe nausea and a drop in blood pressure that can be dangerous.
- Naltrexone blocks opioids, so opioid painkillers will not work and can trigger withdrawal in opioid-dependent people; tell anyone treating you that you take it.
- Disulfiram can increase the effect of warfarin, raising bleeding risk, and can interact with some other medicines such as phenytoin.
- Sedatives and alcohol together with these treatments can worsen drowsiness or unmask other risks, so all medicines should be reviewed.
Patient & carer advice
- These help you stay off alcohol but work best with support and counselling
- With disulfiram, even small hidden amounts of alcohol cause a strong reaction — avoid all sources
- If you are on naltrexone, tell any prescriber before being given opioid painkillers
Use with
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Answers
Alcohol-dependence drugs: frequently asked questions
What happens if I drink alcohol while taking disulfiram?
Disulfiram causes a strong, unpleasant reaction with flushing, a pounding heartbeat, severe nausea and a fall in blood pressure if you drink any alcohol, even small hidden amounts. This can be dangerous, so total avoidance is essential.
Can I take painkillers with naltrexone?
Naltrexone blocks opioid painkillers, so they will not relieve pain and could cause withdrawal if you are opioid dependent. Tell any health professional you take naltrexone, especially before surgery or emergency care.
Do these medicines work on their own?
They work best as part of a wider plan that includes counselling, support groups and lifestyle change. The medicine supports your efforts rather than replacing them.
Are there hidden sources of alcohol I should avoid on disulfiram?
Yes. Some mouthwashes, perfumes, aftershaves, certain foods and some liquid medicines contain alcohol. Check labels and ask your pharmacist, as even small amounts can trigger a reaction.
How long will I need to take these medicines?
The length of treatment depends on the medicine and your progress, and is decided with your team. Acamprosate is usually taken for several months, while disulfiram and naltrexone are reviewed regularly.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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