Can you take naltrexone and acamprosate together?

Combination treatment is used in some cases. Whether it is appropriate for you is a clinical decision based on your history and response to treatment.

Which one has better evidence?

Both are supported by evidence, for somewhat different outcomes. Naltrexone has the stronger evidence for reducing heavy drinking; acamprosate is better studied for maintaining abstinence once achieved.

Which is easier to take?

Naltrexone is usually once daily; acamprosate is typically three times daily. Adherence differences are a real consideration, not a trivial one.

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Naltrexone vs Acamprosate: Which Is Right?

The choice depends less on which is stronger and more on whether you have already stopped drinking.

Medically reviewed by Dr. Nageley Michel, DNP, PMHNP, FNP, Board-Certified Psychiatric Nurse Practitioner · Published 2026-09-09

Naltrexone and acamprosate are both FDA-approved for alcohol use disorder, and they are not competing versions of the same thing. They act on different systems and suit different situations.

The core difference

Naltrexone

For reducing drinking or stopping

Blocks opioid receptors, reducing alcohol's reward. Can be started while you are still drinking. Taken once daily. Best evidence for reducing heavy drinking.

Acamprosate

For staying stopped

Thought to help stabilise glutamate and GABA signalling disrupted by chronic drinking. Generally started after abstinence has begun. Taken three times daily.

Which tends to suit whom

If you are still drinking and want to drink less, naltrexone is the more natural starting point — it targets the reward loop that makes cutting down hard, and it does not require you to stop first.

If you have already stopped and the challenge is staying stopped, acamprosate is designed for that phase, addressing the lingering unsettledness that can follow sustained drinking.

Practical factors matter too. Acamprosate's three-times-daily schedule is harder to sustain than a single daily dose. Kidney function affects acamprosate; liver function and any opioid use affect naltrexone.

If you drink daily or heavily Stopping suddenly after sustained heavy drinking can cause withdrawal that is medically serious — shaking, sweating, a racing heart, confusion, or seizures. Do not stop on your own to "get ready" for treatment. Tell a provider how much and how often you drink; that shapes how treatment is started safely. If you are in medical distress, call 911.

Safety check Naltrexone is not safe to combine with opioids, including prescription pain medication. A provider screens for this and other contraindications during evaluation. Individual results vary, and naltrexone is not a substitute for emergency or detox care.

Talk it through with a provider

A 45–60 minute video evaluation with a board-certified psychiatric provider. Same-week appointments are typical.

Book an Evaluation → Check My Drinking

This article is general health information, not medical advice, and does not create a provider–patient relationship. Only a licensed provider can diagnose alcohol use disorder or determine whether a particular treatment is appropriate for you, after a full evaluation. Individual results vary. EnnHealth provides outpatient telehealth care and is not a detox or emergency service.