Updated: January 17, 2026

Alternatives to Disulfiram If You Can't Fill Your Prescription

Author

Peter Daggett

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How Is Disulfiram Different from Other AUD Medications?
Naltrexone (ReVia, Vivitrol) — First-Line Option
Acamprosate (Campral) — First-Line Option
Comparing Disulfiram, Naltrexone, and Acamprosate
Non-Medication Alternatives and Adjuncts
What to Tell Your Doctor

Can't get disulfiram? Naltrexone, acamprosate, and other FDA-approved options can help you maintain sobriety. Here's what you need to know about each.

Disulfiram has been one of the key tools in alcohol use disorder (AUD) treatment since its FDA approval in 1951. But with an active shortage as of 2026, some patients are finding it impossible to fill their prescription. If that's you, it's important to know that other FDA-approved medications for AUD exist — and some are considered even more effective than disulfiram for certain patients.

The key: don't go without treatment. Talk to your prescriber right away so you can discuss your options before any gap in coverage occurs. Here's a breakdown of what's available.

How Is Disulfiram Different from Other AUD Medications?

Before exploring alternatives, it helps to understand what disulfiram does — and what it doesn't do. Disulfiram works as an aversion agent: it doesn't reduce cravings or ease withdrawal. Instead, it creates a powerful physical deterrent by causing severe nausea, flushing, chest pain, and other unpleasant effects if you drink alcohol while taking it.

The alternatives below work differently. They target cravings and brain chemistry rather than punishing alcohol use. This matters because the right medication depends on your recovery goals, medical history, and what aspect of AUD you're addressing.

Naltrexone (ReVia, Vivitrol) — First-Line Option

Naltrexone is FDA-approved for AUD and works by blocking opioid receptors in the brain, reducing the pleasurable effects of alcohol. It helps reduce cravings and the urge to drink. It does not cause a disulfiram-like reaction.

It comes in two forms:

ReVia (oral naltrexone): 50 mg tablet taken once daily. Generic is widely available and relatively inexpensive — as low as $25-$60/month with GoodRx.
Vivitrol (naltrexone injectable): 380 mg extended-release injection given monthly by a healthcare provider. Eliminates daily pill compliance. More expensive but manufacturer assistance programs can reduce the cost significantly.

Naltrexone is considered a first-line treatment for AUD by most U.S. clinical guidelines, including the American Psychiatric Association (2018). It is generally well tolerated, widely available, and not a controlled substance. You must not be using opioids or have opioid dependence to take naltrexone.

Acamprosate (Campral) — First-Line Option

Acamprosate (brand: Campral) was FDA-approved in 2004 for maintaining abstinence in patients with AUD. It works by modulating glutamate and GABA neurotransmitter systems, helping reduce the anxiety, restlessness, and discomfort of protracted alcohol withdrawal. It is particularly effective for patients who are already abstinent and want to stay that way.

Dosing: 666 mg (two 333 mg tablets) three times daily with meals. The three-times-daily regimen can affect adherence. Acamprosate is not metabolized by the liver, making it a good choice for patients with liver disease — which is relevant for many AUD patients. It is not a controlled substance.

Cost: generic acamprosate is available and typically costs $30-$80/month with discount cards.

Comparing Disulfiram, Naltrexone, and Acamprosate

Here's how these three medications differ at a glance:

Disulfiram: Aversion agent; works only if you drink alcohol; requires high motivation; liver monitoring needed; currently in shortage
Naltrexone: Reduces cravings; can be used even if occasional drinking occurs; widely available; first-line per guidelines; contraindicated with opioid use
Acamprosate: Reduces withdrawal discomfort; best when already abstinent; safe in liver disease; three-times-daily dosing; first-line per guidelines

Non-Medication Alternatives and Adjuncts

If disulfiram is unavailable and you're waiting for a prescription transition, these evidence-based non-medication approaches can support your recovery:

Cognitive behavioral therapy (CBT) for AUD
Motivational enhancement therapy
12-step programs (Alcoholics Anonymous) and SMART Recovery
Intensive outpatient programs (IOP) and residential treatment

What to Tell Your Doctor

If you're switching from disulfiram due to unavailability, be ready to discuss with your prescriber: your history of alcohol use, whether you've tried naltrexone or acamprosate before, any opioid use history (relevant for naltrexone), any liver disease history (relevant for all three medications), and your insurance coverage.

Still want to find disulfiram first? Read our guide on how to find disulfiram in stock near you before considering a switch.

medfinder helps you locate disulfiram at pharmacies near you. Enter your medication, dosage, and location, and medfinder will contact pharmacies to find which ones can fill your prescription — texting you the results.

Frequently Asked Questions

Both are FDA-approved for AUD but work differently. Naltrexone is considered first-line per most U.S. guidelines (including APA 2018) because it reduces cravings and has a better safety profile for most patients. Disulfiram is a second-line option that works as an aversion agent — it's most effective in highly motivated patients who want a hard deterrent. Neither is universally superior; the right choice depends on your individual situation.

Generally, these two medications are not combined. If you are switching from disulfiram to naltrexone, your prescriber will typically have you wait until disulfiram has cleared your system (at least two weeks after your last dose) before starting naltrexone. Always follow your doctor's instructions for transitioning between medications.

Acamprosate is most effective in patients who have already stopped drinking and want to maintain abstinence. Unlike naltrexone, which can be used as a harm-reduction tool even if drinking continues, acamprosate is intended to reduce the physical discomfort of being sober. If you haven't stopped drinking yet, naltrexone may be a better starting point.

Both naltrexone and acamprosate are generally covered by insurance, including most Medicaid plans, Medicare Part D, and commercial insurance. The Affordable Care Act requires coverage of substance use disorder treatment, which includes medication-assisted treatment (MAT). Copays vary by plan but are often $0-$30 for generics.

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