Medicines for drinking
How the medicines for drinking compare, when they're used and when they're not, and how they fit with counselling and GP follow-up.
Not yet reviewed by a doctorUpdated 24 Oct 20264 min read
In short
- Three medicines are approved in Australia to help people who are dependent on alcohol: naltrexone, acamprosate and disulfiram.
- Naltrexone and acamprosate can ease cravings and help people avoid going back to heavy drinking, while disulfiram works as a deterrent by making you feel very unwell if you drink.
- Naltrexone and acamprosate are on the PBS for alcohol dependence; disulfiram is not, so you pay the full price.
- Medicine isn't for everyone. It's used alongside counselling and regular GP follow-up, and you and your GP decide together whether it suits you.
What medicines can help with drinking?
Three medicines are approved in Australia for alcohol dependence: naltrexone, acamprosate and disulfiram. Each works in a different way, and none is right for everyone.
Naltrexone and acamprosate both aim to ease the pull towards drinking. Disulfiram is used less often, and only for people who want to stop completely and have someone to supervise each dose.
How do the medicines for drinking compare?
In short, naltrexone and acamprosate can reduce cravings, while disulfiram makes drinking unpleasant. Here's how they differ.
| Naltrexone | Acamprosate | Disulfiram | |
|---|---|---|---|
| What it does | Blocks some of the rewarding effects of alcohol, which can reduce cravings and the urge to keep drinking | Thought to rebalance brain chemistry that changes with long-term drinking, which can reduce cravings after stopping | Causes an unpleasant reaction, such as flushing, nausea and a pounding heart, if you drink any alcohol |
| Can you start it while still drinking? | Yes, it can be started with or without stopping first | No, it's started after you've stopped and withdrawal has settled | No, you need to have had no alcohol for at least 24 hours |
| How often | Usually one tablet a day | Usually tablets three times a day | Usually one tablet a day, ideally taken while someone watches |
| On the PBS? | Yes, for alcohol dependence, with conditions | Yes, for alcohol dependence, with conditions | No, you pay the full private price |
| Main things to know | Not suitable if you take opioids or may need them for pain, or have serious liver problems | Not suitable with serious kidney problems; diarrhoea is common at first | Any alcohol, even in mouthwash or cooking, can cause a reaction |
Who are medicines for drinking for?
Medicine is usually considered for people who are dependent on alcohol, or who've found it hard to cut down or stop with support alone. It's not usually the first step for people who drink a bit more than they'd like and can cut back with a plan.
Your GP will think about:
- Your goal: cutting down, or stopping.
- Your liver and kidney health, often checked with a blood test.
- Other medicines you take, especially opioids for pain or an opioid treatment program.
- Pregnancy, breastfeeding or plans to become pregnant.
- What has and hasn't helped before.
When is medicine not used for drinking?
Medicine isn't the right choice for everyone, and many people cut down or stop without it.
- When drinking is above the guidelines but you're not dependent, a plan and some support are usually the first step.
- When a health condition or another medicine makes a particular option unsafe.
- To manage withdrawal itself. That uses different, short-term medicine. See cutting down or stopping.
- When you'd rather not take medicine. That's your choice.
Does medicine for drinking work on its own?
Medicine works alongside support, not instead of it. Australian guidelines recommend these medicines as part of a broader plan that includes counselling or other support and regular follow-up with your GP.
The PBS also asks that naltrexone and acamprosate be prescribed as part of a comprehensive treatment program, and regular GP visits are part of that. See counselling and support for what's available.
How do I talk to my GP about medicine for drinking?
Ask whether medicine is an option for you, and what each choice would mean. Your GP will explain the pros and cons, and you'll decide together.
- Would medicine suit my goal and my health?
- What might I notice, and which side effects should I watch for?
- How long would I take it, and how will we review it?
- What will it cost?
- What else should be part of my plan?
Each medicine has its own guide: naltrexone, acamprosate and disulfiram. This is general information, and your GP will talk about what applies to you.
More questions
Are there other medicines for drinking?
These three are the medicines approved in Australia for alcohol dependence. There are other medicines your GP may discuss in some situations, and they can explain whether any would suit you.
Do these medicines make you feel sick if you drink?
Only disulfiram does, by causing a reaction with alcohol. Naltrexone and acamprosate don't cause a reaction if you drink; they aim to reduce cravings.
Are these medicines addictive?
No. None of these three medicines is addictive, and none of them gives a high.
Read next
Sources
- Naltrexone, Guidelines for the Treatment of Alcohol Problems, 2021
- Acamprosate, Guidelines for the Treatment of Alcohol Problems, 2021
- Disulfiram, Guidelines for the Treatment of Alcohol Problems, 2021
- Naltrexone (item 8370M), Pharmaceutical Benefits Scheme
- Acamprosate (item 8357W), Pharmaceutical Benefits Scheme
This page is general information, not advice for you. Talk to a GP about your own situation. Satchel doesn't sell or supply medicines, and no doctor or company paid for this page.