Acamprosate vs naltrexone: How do they compare?
Acamprosate and naltrexone are two different medications that are used in the treatment of alcohol use disorder. They work in different ways to help people who are dependent on alcohol to abstain from drinking it. Naltrexone is also used for the treatment of opioid use disorder.
Acamprosate was thought to be slightly more effective at helping people with alcohol use disorder remain off alcohol, while naltrexone was thought to be slightly more effective at helping reduce heavy drinking and cravings, according to the results of a meta-analysis which used data from 64 trials.
Results from a small study comparing the two drugs, however, indicates that naltrexone was more effective than acamprosate in a number of areas. The study was conducted in 157 men who had recently undergone alcohol detoxification,
The study found there was no difference in the average time to first drink, but naltrexone recipients had a significantly longer time to relapse (five or more drinks in a day) than acamprosate recipients (63 vs 42 days; p = 0.02). Also, more naltrexone recipients had not relapsed after one year compared with acamprosate recipients (41% vs 17%; p = 0.0009). The number of days participants remained sober was also higher in the naltrexone group, while the number of drinks they had at one time and the severity of their cravings was significantly less (p = 0.038). More participants in the acamprosate group than the naltrexone group were started on disulfiram during the study period.
Another study conducted in 160 participants with alcoholism also noted that naltrexone treatment tended to result in longer times to first drink and relapse compared with acamprosate treatment.
| Acamprosate | Naltrexone | |
|---|---|---|
| Dosage Form |
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| Generic / brand names |
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| FDA approval date | 2004 |
1984 (tablet)
2006 (extended-release intramuscular injection) |
| Administration |
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| Dosing schedule |
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| Indication / usage |
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You should stop drinking alcohol or using opioids before starting naltrexone. |
| Drug type | A small molecule analog of gamma-aminobutyric acid (GABA) and taurine | A small molecule opioid antagonist |
| Mechanism of action | The exact mechanism is unclear, but it’s thought to work by targeting GABA and N-methyl-D-aspartate (NMDA) | Opioid antagonist |
| Side effects / adverse effects |
Common adverse events that occurred in 3% or greater (and greater than the placebo group in controlled clinical trials) of patients include:
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Common adverse events that occur in more than 10% of patients being treated for alcohol use disorder with naltrexone tablets include:
Common adverse events that occurred in more than 10% of patients being treated for opioid addiction with naltrexone tablets include:
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| Warnings and precautions |
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| Special patients populations |
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Related Questions
References
- Maisel NC, Blodgett JC, Wilbourne PL, Humphreys K, Finney JW. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction. 2013;108(2):275-293. doi:10.1111/j.1360-0443.2012.04054.x.
- Rubio G, Jiménez-Arriero MA, Ponce G, Palomo T. Naltrexone versus acamprosate: one year follow-up of alcohol dependence treatment [published correction appears in Alcohol Alcohol 2002 Jan-Feb;37(1):105]. Alcohol Alcohol. 2001;36(5):419-425. doi:10.1093/alcalc/36.5.419.
- Kiefer F, Jahn H, Tarnaske T, et al. Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2003;60(1):92-99. doi:10.1001/archpsyc.60.1.92.
- National Library of Medicine. Zydus Pharmaceuticals Acamprosate Calcium Delayed Release Tablet Product Label. [Accessed November 9, 2022]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9803db35-2600-4f42-80c1-43216fd1ba3d&audience=consumer.
- National Library of Medicine. Chartwell Rx, LLC Naltrexone Hydrochloride Film Coated Tablets Product Label. [Accessed November 9, 2022]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adb7c4dc-221a-4d91-9687-0d78913a92ad&audience=consumer.
- National Library of Medicine. Vivitrol - Naltrexone Kit Product Label. [Accessed November 9, 2022]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cd11c435-b0f0-4bb9-ae78-60f101f3703f.
- Electronic Medicines Compendium (EMC). Adepend 50 mg Film-Coated Tablets Package Leaflet. [Accessed November 9, 2022]. Available from: https://www.medicines.org.uk/emc/files/pil.3559.pdf.
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