Acamprosate vs Naltrexone for Alcohol: Side-by-Side Comparison (2026)

An evidence-based comparison to help you choose the right treatment approach. Data sourced from SAMHSA, NIDA, and published research.

RehabFlow Editorial Team • Updated: Apr 5, 2026

Quick Verdict

Choose Acamprosate (Campral) if:

You have you have already achieved abstinence and want to maintain it, experience post-acute withdrawal symptoms, or cannot take naltrexone.

Choose Naltrexone (Vivitrol/ReVia) if:

You have you want to reduce cravings and drinking, prefer a monthly injection option, or are still actively drinking.

Not sure? Call (833) 567-5838 for a free clinical assessment.

Head-to-Head Comparison

Feature	Acamprosate (Campral)	Naltrexone (Vivitrol/ReVia)
How It Works	Restores brain chemical balance (GABA/glutamate)	Blocks opioid receptors, reduces reward from drinking
When to Start	After achieving abstinence	Can start while still drinking
Administration	2 pills, 3 times daily	Daily pill or monthly injection (Vivitrol)
Main Benefit	Maintains abstinence, reduces PAWS	Reduces cravings and heavy drinking days
Side Effects	Diarrhea (most common), nausea	Nausea, headache, injection site reactions
Liver Concerns	Safe for liver disease	Requires liver function monitoring
Opioid Use	No interaction	Cannot use opioids (blocks them)
Cost/Month	$150-$300 (generic available)	$50 (oral) / $1,000-$1,500 (Vivitrol)
Insurance	Covered (generic available)	Covered (Vivitrol may need prior auth)
Evidence Strength	Strong (European studies)	Strong (US studies)

How It Works

Acamprosate (Campral)

Restores brain chemical balance (GABA/glutamate)

Naltrexone (Vivitrol/ReVia)

Blocks opioid receptors, reduces reward from drinking

When to Start

Acamprosate (Campral)

After achieving abstinence

Naltrexone (Vivitrol/ReVia)

Can start while still drinking

Administration

Acamprosate (Campral)

2 pills, 3 times daily

Naltrexone (Vivitrol/ReVia)

Daily pill or monthly injection (Vivitrol)

Main Benefit

Acamprosate (Campral)

Maintains abstinence, reduces PAWS

Naltrexone (Vivitrol/ReVia)

Reduces cravings and heavy drinking days

Side Effects

Acamprosate (Campral)

Diarrhea (most common), nausea

Naltrexone (Vivitrol/ReVia)

Nausea, headache, injection site reactions

Liver Concerns

Acamprosate (Campral)

Safe for liver disease

Naltrexone (Vivitrol/ReVia)

Requires liver function monitoring

Opioid Use

Acamprosate (Campral)

No interaction

Naltrexone (Vivitrol/ReVia)

Cannot use opioids (blocks them)

Cost/Month

Acamprosate (Campral)

$150-$300 (generic available)

Naltrexone (Vivitrol/ReVia)

$50 (oral) / $1,000-$1,500 (Vivitrol)

Insurance

Acamprosate (Campral)

Covered (generic available)

Naltrexone (Vivitrol/ReVia)

Covered (Vivitrol may need prior auth)

Evidence Strength

Acamprosate (Campral)

Strong (European studies)

Naltrexone (Vivitrol/ReVia)

Strong (US studies)

Key Differences Explained

Acamprosate and naltrexone are both FDA-approved medications for alcohol use disorder, but they work through completely different mechanisms and serve different clinical purposes.

Acamprosate (Campral) works by restoring the balance of brain chemicals (GABA and glutamate) disrupted by chronic alcohol use. It's most effective for people who have already stopped drinking and want to maintain abstinence. It reduces the post-acute withdrawal symptoms — anxiety, insomnia, restlessness — that drive early relapse.

Naltrexone blocks opioid receptors in the brain, reducing the pleasurable effects of alcohol. It can be taken as a daily pill (ReVia) or monthly injection (Vivitrol). Unlike acamprosate, naltrexone can be started while you're still drinking — it reduces heavy drinking days and cravings.

Can You Take Both?

Yes. The COMBINE study (the largest alcohol medication trial ever) found that combining naltrexone with behavioral therapy produced the best outcomes. Adding acamprosate didn't significantly improve results in this US study, though European trials showed stronger acamprosate effects. Some clinicians prescribe both for patients with severe alcohol dependence.

What About Disulfiram?

A third option, disulfiram (Antabuse), works through aversion — making you violently ill if you drink. It's effective for highly motivated patients but has compliance challenges.

Not Sure Which Is Right for You?

Our treatment specialists can assess your situation and recommend the right level of care. Free, confidential, 24/7.

(833) 567-5838

Frequently Asked Questions

Which medication is more effective for alcohol addiction?

Neither is clearly superior overall. Naltrexone is better for reducing heavy drinking and cravings. Acamprosate is better for maintaining complete abstinence once achieved. The COMBINE study favored naltrexone + therapy, but individual response varies. Your doctor should choose based on your specific situation.

Can I take acamprosate if I have liver problems?

Yes — this is acamprosate's major advantage. It's processed by the kidneys, not the liver, making it safe for patients with alcohol-related liver disease. Naltrexone requires liver function monitoring and may not be suitable for significant liver damage.

How long do I need to take these medications?

Most guidelines recommend at least 3-12 months, with some patients benefiting from longer treatment. Like medications for high blood pressure, stopping too early often leads to return of symptoms. Discuss duration with your prescriber.

What if I relapse while taking the medication?

Relapse doesn't mean the medication isn't working. Continue taking it — both medications reduce the severity and duration of relapse episodes. Tell your prescriber so they can adjust the treatment plan.

Acamprosate vs Naltrexone for Alcohol: Side-by-Side Comparison (2026)

Quick Verdict

Head-to-Head Comparison

Key Differences Explained

Can You Take Both?

What About Disulfiram?

Not Sure Which Is Right for You?

Frequently Asked Questions

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