While both medications support recovery efforts, they work differently and have distinct characteristics.
How Does Antabuse Work?
Antabuse works by interfering with the body’s ability to break down alcohol. When someone taking Antabuse consumes alcohol, they experience an extremely unpleasant reaction that includes nausea, vomiting, headache, and flushing. This negative reinforcement aims to deter individuals from drinking.[1]
How Does Naltrexone Work?
Naltrexone is an opioid antagonist, meaning it blocks the pleasurable effects of alcohol. When someone taking naltrexone drinks alcohol, they don’t experience the usual “buzz” or euphoric feelings that alcohol typically produces. This can reduce the motivation to drink and the likelihood of heavy drinking episodes.[2]
Comparing Antabuse & Naltrexone
Understanding the similarities and differences between Antabuse and naltrexone can help you make an informed decision about the best medication for you. Explore the chart below to learn how the two medications compare on a variety of topics:[1,2]
| Antabuse | Naltrexone | |
| What They Are Used For | To help maintain abstinence from alcohol once detox has occurred | To reduce cravings for alcohol and reduce the severity of heavy drinking episodes |
| Drug Schedule | Not scheduled | Schedule IV drug |
| Forms | Oral tablet | Oral tablet, extended-release intramuscular injection |
| How They Are Used | Swallowed daily by mouth | Taken in oral form daily or injected once per month |
| Common Side Effects | Headaches, tiredness, impotence, metallic taste in mouth, stomach pain, and vomiting | Nausea, headache, stomach pain, dizziness, and fatigue |
| Addition Potential | None | Low |
| Cost | Cost varies depending on generic or brand name and insurance coverage but is generally affordable | Can be more expensive, especially in the intramuscular injection form |
| Insurance Coverage | Generally covered by insurance | Generally covered by insurance |
| Efficacy & Safety | Considered safe and effective for most people | Considered effective and safe, but specific factors influence success |
Key Differences Between Antabuse & Naltrexone
There are key differences between Antabuse and naltrexone that inform treatment outcomes. While they have a similar goal of reducing alcohol use, the end goal of each medication varies. Factors that vary among the two drugs include their available doses, how they are consumed, and the treatment protocols they require.
Treatment Goal
Antabuse is primarily used to support complete abstinence, while naltrexone can be used for harm reduction and to reduce alcohol cravings. For people who want help drinking less alcohol, naltrexone may be a good medication, though it can also assist those who want to completely quit drinking.
Antabuse can only be used with the goal of complete abstinence. Any bit of alcohol consumed while taking Antabuse will result in negative effects on the body.
Dosing Ranges
The dosing ranges of naltrexone and Antabuse vary significantly, which means one may better suit your needs than the other. Antabuse is available in 250 mg and 500 mg tablets that are meant to be taken daily. Antabuse dosing usually starts at 500 mg daily for a few days and then decreases to a maintenance dose (often 250 mg daily).[4] The number of doses you take per day is decided by your healthcare provider.
The recommended dose of naltrexone is 380 mg, which is administered once per month via an injection.[5]
How the Medications Are Administered
Antabuse is an oral tablet taken daily, while naltrexone is available as an oral tablet but is most commonly given as a monthly injection. The injection is only FDA-approved to be administered by a trained healthcare professional, as injecting the medication wrong can cause serious health consequences.
Is One Medication Better for Quitting Alcohol?
There’s no simple answer to whether Antabuse or naltrexone is better. The most suitable medication depends on individual needs and preferences.
A meta-analysis of several studies found both medications to be effective in the treatment of AUD, with some evidence suggesting Antabuse may be slightly more effective in promoting abstinence.[3] However, naltrexone’s harm-reduction approach can be beneficial for certain individuals.[6]
Choosing the Right AUD Medication
The choice between Antabuse and naltrexone is highly personalized. Your doctor will assess your individual situation, discuss potential risks and benefits, and help you determine the best medication for your recovery journey. Remember, a comprehensive approach that combines medication, therapy, and other efforts is vital for sustained recovery from AUD.[7]
- Disulfiram. U.S. National Library of Medicine. Published August 15, 2017. Accessed March 20, 2024.
- Naltrexone. Substance Abuse and Mental Health Services Administration. Published January 30, 2024. Accessed March 20, 2024.
- Jonas, E., Amick, H., Feltner, C., et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):188901900.
- Disulfiram. Medical Professionals Reference. Accessed March 22, 2024.
- Vivitrol (Naltrexone for extended–release injectable suspension), for intramuscular use. Vivitrol.com. Published September 2022. Accessed March 22, 2024.
- Helstrom AW, Blow FC, Slaymaker V, Kranzler HR, Leong S, Oslin D. Reductions in alcohol craving following naltrexone Tteatment for heavy drinking. Alcohol and Alcoholism. 2016;51(5):562-566.
- Ray LA, Meredith LR, Kiluk BD, Walthers J, Carroll KM, Magill M. Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders. JAMA Network Open. 2020;3(6):e208279.
