Medication	FDA approved for alcohol use disorder	Dosage	Adverse effects	Contraindications*	Comments	Cost†
Acamprosate‡ (Campral)	Yes	Two 333-mg enteric-coated tablets three times per day Moderate renal impairment (creatinine clearance of 30 to 50 mL per minute per 1.73 m² [0.50 to 0.83 mL per second per m²]): initially, one tablet three times per day	Diarrhea, insomnia, anxiety, depression, asthenia, anorexia, pain, flatulence, nausea, dizziness, pruritus, dry mouth, paresthesia, sweating	Severe renal impairment (creatinine clearance < 30 mL per minute per 1.73 m²)	Pregnancy category C, safety unknown in breastfeeding	$55 ($145)
Disulfiram (Antabuse)	Yes	Begin with 250 mg once per day; if not effective, increase to 500 mg once per day	Disulfiram-alcohol interaction: flushing, palpitations, nausea, vomiting, headache Optic neuritis, peripheral neuritis, polyneuritis, peripheral neuropathy, hepatitis, drowsiness, fatigability, impotence, headache, acneiform eruptions, allergic dermatitis, metallic or garlic-like aftertaste	Alcohol, metronidazole (Flagyl), or paraldehyde use; psychosis; cardiovascular disease	Initiate only after patient has abstained from alcohol for at least 12 hours Patient should carry an identification card describing the disulfiram-alcohol interaction; liver function should be monitored for hepatotoxicity Pregnancy category C, safety unknown in breastfeeding	$50 ($190)
Fluoxetine (Prozac)	No	Begin with 20 mg per day; may increase to 60 to 80 mg per day	Ejaculatory dysfunction, nausea, headache, insomnia, nervousness, somnolence, anxiety, diarrhea, anorexia, dry mouth, tremor, asthenia, sweating, dyspepsia, influenza-like illness, serotonin syndrome FDA warning§	Use of an MAOI such as mesoridazine (Serentil), thioridazine, or linezolid (Zyvox)	Recommended only in patients with comorbid depression Pregnancy category C, safety unknown in breastfeeding	$4 ($330)
Gabapentin (Neurontin)	No	Variable Studies have used 300 mg twice per day or once-daily dosages up to 1,800 mg at bedtime Could begin with 300 mg per day on the first day, then 300 mg twice per day on the second day and 300 mg three times per day on the third day; may increase to maximum dosage of 1,800 mg per day	Dizziness, somnolence, fatigue, peripheral edema, hostility, diarrhea, asthenia, infection, dry mouth, nystagmus, constipation, nausea, vomiting, ataxia, fever, amblyopia	None	Use lower dose if patient has renal impairment (creatinine clearance < 60 mL per minute per 1.73 m² [1.00 mL per second per m²]) Decreases levels of hydrocodone in a dose-dependent manner Decreased bioavailability with aluminum hydroxide/magnesium hydroxide Opioids may increase levels of gabapentin Pregnancy category C, limited data that it is safe in breastfeeding	$11 ($200)
Naltrexone (Revia [oral], Vivitrol [injectable])‡	Yes	Oral: 50 to 100 mg per day (alternative dosing: 50 mg every weekday with a 100-mg dose on Saturday, 100 mg every other day, or 150 mg every third day) Injectable: 380 mg once every four weeks	Nausea, vomiting, headache, dizziness, nervousness, fatigue, low energy, insomnia, anxiety, difficulty sleeping, abdominal pain or cramps, joint or muscle pain	Opioid use, acute opioid withdrawal, acute hepatitis, liver failure	Liver function tests should be performed to monitor for hepatotoxicity Pregnancy category C, safety unknown in breastfeeding	Oral: $45 ($106) Injectable: not available ($1,300)
Ondansetron (Zofran)	No	4 mcg per kg twice per day (higher dosages may be used); available in 4-mg, 8-mg, 16-mg, and 24-mg oral doses	Malaise, fatigue, headache, dizziness, anxiety, serotonin syndrome; QT interval prolongation and torsades de pointes have been reported	Apomorphine use	Patients with electrolyte abnormalities should be monitored with electrocardiography Should be avoided in patients with congenital long QT syndrome Pregnancy category B, safety unknown in breastfeeding	$20 ($670)
Sertraline (Zoloft)	No	Begin with 50 mg per day; may increase to 200 mg per day	Ejaculatory dysfunction, dry mouth, sweating, somnolence, fatigue, tremor, anorexia, dizziness, headache, diarrhea, dyspepsia, nausea, constipation, agitation, insomnia, serotonin syndrome FDA warning§	Use of an MAOI such as mesoridazine, thioridazine, or linezolid	May be helpful in patients with comorbid depression when prescribed in conjunction with naltrexone Pregnancy category C, safe in breastfeeding	$10 ($210)
Topiramate (Topamax)	No	Begin with 25-mg dose; increase to a total of 300 mg given twice per day in divided doses Renal impairment (creatinine clearance < 60 mL per minute per 1.73 m² [1.17 mL per second per m²]): one-half of usual dosage	Hyperchloremic, nonanion gap, metabolic acidosis; acute myopia associated with secondary angle-closure glaucoma has been reported Anorexia, anxiety, diarrhea, fatigue, fever, infection, weight loss, cognitive problems, paresthesia, somnolence, taste perversion, mood problems, nausea, nervousness, confusion	None	Serum bicarbonate and blood ammonia levels should be monitored Pregnancy category D, safety unknown in breastfeeding	$10 ($140)