Medications for alcohol dependence: When to prescribe

If a patient is alcohol dependent and they want to reduce or stop drinking, the use of medications as part of an overall treatment strategy enhances the likelihood of success.

1. Assess likelihood of withdrawal and consider appropriate treatment.

Visit the Management of substance withdrawal page for more information.

2. Three medications are available in Australia for assisting abstinence from alcohol:

Acamprosate and naltrexone:

  • PBS listed for 'alcohol dependence, with a goal of abstinence in a comprehensive treatment program'
  • can prescribe one month's supply and one repeat at a time; there is no limit on duration of treatment
  • acamprosate is effective at maintaining abstinence, but has less impact on relapse to heavy drinking once alcohol consumption is recommenced, whereas naltrexone is effective in preventing relapse to heavy drinking and is less effective at maintaining abstinence
  • may be used in combination
  • doses: acamprosate two tablets TDS (less if <60kg); naltrexone one tab daily.

Disulfiram:

  • not PBS listed; cost to patient approx $80-90 per month
  • has been less well researched, but is well known by patients and their families
  • variable results with modest effect, enhanced by supervision of ingestion
  • small DASSA-funded program for existing clients in whom other treatment options have failed
  • can be used with acamprosate (not recommended with naltrexone).

Useful resources

The Pharmacotherapies indicated for alcohol dependence (PDF 17KB) factsheet describes what each of these medications does, when to start treatment, the term of the treatment, side effects, contraindications and precautions.

For information about the effectiveness of different medications in relapse prevention, see DASSA Monograph No. 26: Pharmacotherapies for relapse prevention in alcohol dependence (PDF 4830KB)

Clients can be referred to the Medication-assisted treatment for alcohol dependence page for more information about drug treatment and how it works,

Further information and advice

  • Alcohol and Drug Information Service (ADIS) 1300 13 1340

  • Drug and Alcohol Clinical Advisory Service (DACAS).
    DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.

    • Telephone: (08) 7087 1742 from 8.30 am to 10.00 pm 7 days/week including public holidays or e-mail your enquiry to: HealthDACASEnquiries@sa.gov.au.  
    Out of these hours, medically urgent calls from a hospital based Medical Consultant or country hospital medical officer/GP will always receive a response.

    This service does not provide proxy medical cover and cannot assume responsibility for direct patient care.