When Acamprosate Isn't Available, You Still Have Options

If you've been taking Acamprosate (formerly sold as Campral) to support your sobriety and suddenly can't find it at your pharmacy, it's natural to feel anxious. The ongoing Acamprosate shortage has left many patients scrambling for solutions.

The most important thing to know: you have alternatives. Several other medications are FDA-approved or commonly used off-label for alcohol use disorder. This article walks through your options so you can have an informed conversation with your doctor.

What Is Acamprosate and How Does It Work?

Acamprosate Calcium is an FDA-approved medication that helps people with alcohol dependence maintain abstinence after they've stopped drinking. It's a structural analogue of GABA (gamma-aminobutyric acid) that works by restoring the balance between excitatory (glutamate) and inhibitory (GABA) neurotransmission in the brain.

Chronic alcohol use disrupts this balance. When you stop drinking, your brain is left in a hyperexcitable state that can cause cravings, anxiety, and restlessness. Acamprosate helps calm this overactivity, making it easier to stay sober.

The standard dose is two 333 mg tablets taken three times daily (six tablets per day). It's not a controlled substance and has very few drug interactions, which makes it a popular choice — especially for patients taking multiple medications.

Alternative 1: Naltrexone (Oral and Injectable)

Naltrexone is the most commonly recommended alternative to Acamprosate. It's FDA-approved for alcohol use disorder and works differently — it blocks opioid receptors in the brain, which reduces the rewarding and pleasurable effects of alcohol.

Key facts about Naltrexone:

• Oral form: 50 mg tablet taken once daily (brand name ReVia)
• Injectable form: 380 mg intramuscular injection given once monthly (brand name Vivitrol)
• How it helps: Reduces cravings and the "high" from drinking, which can help prevent relapse
• Cost: Generic oral Naltrexone is very affordable — often under $30/month with a coupon. Vivitrol injections are more expensive ($1,000-$1,800/month) but often covered by insurance.
• Key difference from Acamprosate: Naltrexone works best for patients who want to reduce heavy drinking or prevent relapse, while Acamprosate is specifically designed to maintain abstinence

Important: Naltrexone cannot be used by patients currently taking opioid medications or those with acute hepatitis or liver failure. Your doctor will check your liver function before prescribing it.

Alternative 2: Disulfiram (Antabuse)

Disulfiram takes a completely different approach. Instead of reducing cravings, it creates a strong deterrent to drinking by causing extremely unpleasant physical reactions if you consume any alcohol.

Key facts about Disulfiram:

• Dose: 250 mg tablet taken once daily
• How it works: Blocks the enzyme aldehyde dehydrogenase, causing a buildup of acetaldehyde if alcohol is consumed. This leads to flushing, nausea, vomiting, headache, and rapid heartbeat.
• Best for: Highly motivated patients who want a strong physical deterrent to drinking
• Cost: Generic Disulfiram is affordable — typically $20-$60/month with a coupon
• Key consideration: You must be completely alcohol-free (including hidden alcohol in foods, mouthwash, etc.) while taking Disulfiram. It also requires regular liver function monitoring.

Disulfiram is not considered a first-line treatment anymore, but it can be very effective for the right patient — particularly someone with strong motivation and good support systems.

Alternative 3: Gabapentin (Off-Label)

Gabapentin is an anticonvulsant medication that's increasingly used off-label for alcohol use disorder, especially in patients who also have anxiety, insomnia, or neuropathic pain.

Key facts about Gabapentin:

• Dose: Typically 900-1,800 mg/day, divided into three doses
• How it helps: Reduces alcohol cravings, improves sleep, and may ease anxiety — all common triggers for relapse
• Cost: Very affordable — generic Gabapentin can cost under $15/month
• Key consideration: Not FDA-approved for alcohol use disorder, so this is an off-label use. Some states classify Gabapentin as a controlled substance due to misuse potential.

Alternative 4: Topiramate (Off-Label)

Topiramate is another anticonvulsant used off-label for alcohol use disorder. Clinical studies have shown it can reduce heavy drinking days and increase abstinence rates.

Key facts about Topiramate:

• Dose: Typically titrated up to 200-300 mg/day
• How it helps: Thought to modulate both glutamate and GABA systems — similar to Acamprosate's target pathways
• Cost: Generic Topiramate is affordable — usually under $20/month
• Key consideration: Can cause cognitive side effects ("brain fog"), tingling in hands and feet, and weight loss. Requires slow dose titration.

How to Talk to Your Doctor About Switching

If you can't find Acamprosate, schedule an appointment with your prescriber (or use a telehealth visit) to discuss alternatives. Here's what to bring up:

• How long you've been taking Acamprosate and how well it's been working
• Any other medications you're taking (especially opioids, which would rule out Naltrexone)
• Whether you have any liver or kidney issues
• Your preferences — some patients prefer a daily pill, while others like the accountability of a monthly injection
• Your insurance coverage and budget

Don't Give Up on Finding Acamprosate

Before switching medications, it's worth trying to find Acamprosate first. Use Medfinder to check pharmacy stock near you — the shortage doesn't mean it's completely unavailable, just harder to find.

Final Thoughts

Losing access to a medication that's been helping you stay sober is scary, but you're not out of options. Naltrexone, Disulfiram, Gabapentin, and Topiramate all offer real support for alcohol use disorder. The best alternative for you depends on your medical history, other medications, and personal preferences.

Talk to your doctor, explore your options, and don't let a drug shortage stand between you and your recovery. For more on the shortage itself, see our 2026 Acamprosate shortage update.