| Acamprosate (Campral) | Yes | 333-mg enteric coated tablets Adults ≥ 132 lbs (60 kg): two tablets three times per day | Diarrhea, headache, flatulence, nausea, vomiting, dyspepsia | Severe renal impairment (creatinine clearance < 30 mL per minute [0.5 mL per second]) | To avoid adverse gastrointestinal effects, initial dosing usually is at one half the given dosages with an increase of one tablet to the daily dosage each week. | $125 |
| Adults < 132 lbs: two tablets with the morning meal, one with the midday meal, and one with the evening meal |
| Disulfiram (Antabuse) | Yes | Begin with 250 mg once per day; increase to 500 mg once per day. | Disulfiram–alcohol interaction: palpitations, flushing, nausea, vomiting, headache | Alcohol, metronidazole (Flagyl), or paraldehyde use psychosis; cardiovascular disease | Initiate only after patient has abstained from alcohol for at least 12 hours. | 42 |
| Not generally recommended for treating alcohol dependence in the primary care setting |
| Patient should carry an identification card describing the disulfiram–alcohol interaction. |
| Monitor liver function tests for hepatotoxicity. |
| Fluoxetine (Prozac) | No | Begin with 20 mg per day; may increase to 60 mg per day as needed. | Nausea, headache, sedation, anxiety, sexual dysfunction | Use of an MAOI, mesoridazine (Serentil), or thioridazine (Mellaril) | Recommended only in patients with comorbid depression | 127 (79 to 89 generic) |
| Nalmefene (Revex) | No | Available only in an injectable form (outside of research) to treat opiate overdose. | Nausea, tachycardia, vasodilation, dizziness, headache, chills, vomiting | None | — | 62 (for 2 mL [2 mg]) |
| Naltrexone (Trexan) | Yes | 50 mg once per day | Nausea, headache, anxiety, sedation | Narcotic use, acute opioid withdrawal, acute hepatitis, liver failure | Monitor liver function tests for hepatotoxicity. | 205 (128 to 137 generic) |
| Ondansetron (Zofran) | No | 4 mcg per kg twice per day | Malaise, fatigue, headache, dizziness, anxiety | None | — | 661 (for 4 mg daily) |
| Topiramate (Topamax) | No | Begin with 25 mg morning dose and increase to a total of 300 mg given twice a day in divided doses. | Recent FDA warning of metabolic acidosis, especially with renal or liver disease | None | Consider interactions withother anticonvulsant drugs. | 53 |
| Dizziness, somnolence, ataxia, impaired concentration, confusion, fatigue, paresthesias, speech difficulties, diplopia, nausea |