Each of these medications works a bit differently to support people in reducing or stopping alcohol use.

• Naltrexone helps reduce cravings and the “reward” feeling some people get from drinking. It’s one of the most well-studied medications for alcohol use disorder and has been shown in multiple large clinical trials to help people drink less and avoid relapse. It has been used safely for decades in a variety of treatment settings.

• Acamprosate helps your brain regain balance after cutting back or quitting alcohol, which can reduce withdrawal-related anxiety or restlessness. Acamprosate is backed by a strong body of research showing its effectiveness, particularly when combined with counseling or support.

• Semaglutide, tirzepatide, and liraglutide may reduce cravings and interest in alcohol. GLP-1 medications were originally developed for diabetes and weight loss, but early research suggests they may also help people drink less.
  
  A recent clinical trial of semaglutide among adults with alcohol use disorder found that, compared to individuals who were taking a placebo, individuals taking semaglutide drank less alcohol and had reduced alcohol cravings. Among a subset of participants who also smoked, semaglutide was also associated with reductions in smoking.
  
  Other studies of medical records have found that individuals who were prescribed GLP-1s were less likely to have diagnoses of alcohol use disorder, alcohol intoxication, and alcohol-related hospitalizations compared to individuals who were not prescribed GLP-1s. This is an evolving area of research and there are additional clinical trials currently underway.
  
  Note: The use of semaglutide, tirzepatide, and liraglutide for alcohol use disorder is considered off-label, which means the FDA has not approved them for this purpose. However, prescribers may recommend them based on emerging scientific evidence and clinical judgment.

This is a common question! Generally it’s not believed that GLP-1s interact with Vivitrol (the shot version of naltrexone). However, both medications can cause nausea. So a medical provider may recommend staggering the start of these two medications to make sure someone doesn’t develop severe nausea—and also explore if medication for nausea will help, too. A medical provider will assess for the best way forward.

The original hormone that led to the development of medications, exendin-4, was discovered around 1992, and studies for diabetes began thereafter, with the first GLP-1 approved by the FDA for diabetes in 2005. The neuroscientific overlaps between obesity and substance use began to surface in the early 2000s, with the first animal studies of GLP-1s for substance use disorders taking place in the 2010s. The results from the first clinical trial of exenatide (also known as Saxenda or Victoza) in humans was published in 2022. The results from the first clinical trial of semaglutide (also known as Ozempic or Wegovy) was published in 2025. Ongoing trials of GLP-1s for alcohol use disorder can be found on clinicaltrials.gov.

Possibly. Clinical research shows that medications like naltrexone and acamprosate are most effective while you're actively taking them. Staying on naltrexone or acamprosate long-term is not only safe—it’s recommended by experts for people who find doing so helpful. Studies have found that stopping these medications can increase the risk of relapse—especially within the first few months of treatment—because cravings and alcohol-related triggers may return. That said, not everyone experiences a return of cravings right away. Some people maintain progress after stopping, particularly if they’ve built strong routines, support systems, or therapy tools.

With GLP-1 medications, there isn’t enough evidence yet to know whether long-term treatment is needed when using in an off-label setting for alcohol use disorder. So far, the evidence suggests that, for people who are using GLP-1 medications for weight loss, when people stop taking medications they often regain weight.

The decision to continue or stop should be made together with your healthcare provider, based on your goals, experience, and risk of return to use. If you're considering stopping your medication, we recommend doing it under medical supervision. We can help you monitor for any changes, manage symptoms, and decide together if tapering or switching to a different medication is a better option.

• Naltrexone: Generally, side effects are mild, and may include nausea, headache, dizziness, tiredness, and rarely liver irritation. Rarely, it can cause mood changes.
  
  

• Acamprosate: Generally, side effects are mild. Diarrhea is the most common side effect, and it usually goes away with time. Some people may also feel anxious or have trouble sleeping. Rarely, it can cause mood changes.
  
  
• GLP-1s: Common side effects include nausea, vomiting, constipation, diarrhea, decreased appetite, and weight loss. These symptoms are most likely to occur when starting or increasing the dose and often improve over time as your body adjusts. Rarely, GLP-1s may cause more serious side effects, including:
  • Pancreatitis (inflammation of the pancreas), which can cause severe stomach pain or require hospitalization.
    
    
  • Gallbladder issues, such as gallstones or inflammation, especially during rapid weight loss.
    
    
  • Kidney problems, particularly if vomiting or diarrhea leads to dehydration.
    
    
  • Gastroparesis (slowed stomach emptying), which can lead to ongoing nausea, bloating, or early fullness.
    
    
  • Possible thyroid concerns: Animal studies linked GLP-1s to thyroid tumors, including medullary thyroid carcinoma. While this hasn’t been shown in humans, people with a personal or family history of this cancer or MEN2 syndrome should not take GLP-1s.
    
    
  • Vision changes: This can be due to non-arteritic anterior ischemic optic neuropathy, a rare condition that can cause sudden vision loss, or due to worsening of diabetic retinopathy (where rapid improvement in chronically elevated blood sugar can worsen vision). While not common, any sudden changes in vision should be reported immediately.
    
    

If you experience serious symptoms—such as severe abdominal pain, vision changes, or signs of dehydration—please contact your provider right away.

We'll monitor you closely and help manage any side effects if they arise.

Possibly. Generally, for weight loss and diabetes, GLP-1 medications are started at a low dose to minimize side effects and gradually increased, as clinically appropriate. A recent clinical trial testing semaglutide for alcohol use disorder used a similar increasing dosing schedule (increasing the dose at 4 weeks and again at 8 weeks). However, not everyone may need the maximum dose or increased dosing. Our licensed clinicians will work with you to find the clinically appropriate dose for you.

Generally, no. None of these medications is at all like Antabuse, which discourages drinking by making you sick if you consume alcohol.

• Naltrexone: You won’t feel physically sick from drinking, but alcohol may feel less rewarding or pleasurable.
• Acamprosate: It does not cause sickness when drinking.
• GLP-1s: These don’t interact directly with alcohol but may lower your interest in drinking. Drinking on GLP-1s can worsen nausea or cause unexpected effects such as slower absorption of alcohol, heartburn, abdominal discomfort, or other effects.

Yes—the use of GLP-1s for cutting back on alcohol or for alcohol use disorder is considered off-label. That means the FDA has approved them for other conditions (like type 2 diabetes, obesity, overweight with at least one weight-related condition, sleep apnea), but not specifically for alcohol use. Prescribers may, and commonly do, prescribe medications for purposes that the FDA has not specifically approved, especially when supported by research and clinical experience.

Early evidence suggests that GLP-1s can reduce alcohol use and related health conditions. A recent clinical trial of semaglutide among adults with alcohol use disorder found that, compared to individuals who were taking a placebo, individuals taking semaglutide drank less alcohol and had reduced alcohol cravings. Among a subset of participants who also smoked, semaglutide was also associated with reductions in smoking. Other studies of medical records have found that individuals who were prescribed GLP-1s were less likely to have diagnoses of alcohol use disorder, alcohol intoxication, and alcohol-related hospitalizations compared to individuals who were not prescribed GLP-1s. This is an evolving area of research and there are additional clinical trials currently underway. Your provider will work with you to understand your preferences and past medical history to create a treatment plan tailored to you and your needs.

Disclaimer: The prescribing of medications that have not been FDA-approved for alcohol use disorder for such purpose is based on the provider’s determination of clinical appropriateness, judgment and available evidence.

Right now, there aren’t official dosing guidelines for semaglutide specifically for alcohol use. The research that’s been done so far has used the same schedule that’s recommended for weight management, but, because the trials only lasted a few weeks, the maximum dose reached was 1 mg (instead of 2mg that is sometimes used in weight loss). After a comprehensive assessment, a medical provider usually will start at a low dose and increase gradually, following the standard schedule.

There is one GLP-1 medication that comes in a pill form (semaglutide—with the pill being sold under the brand name Rybelsus), and it is similarly used to reduce complications from diabetes and heart disease. It is currently being studied for alcohol use, but the results of the trial are not available yet (as of September 2025).

Your provider will work with you to choose the most apprpriate medication or medications based on your health history and preferences. They will guide you through the options to make a shared decision, as clinically appropriate.

There is variability in the BMI thresholds that have been used in studies on GLP-1s and alcohol, but the first published trial of semaglutide excluded people with a BMI less than 23. If someone has a lower BMI than that, they may want to consider naltrexone or acamprosate. Regardless of what medication someone takes, it is recommended to have a healthy diet with calories that come from protein and vegetables rather than from sugary foods.

No matter what their BMI, if someone is started on a GLP-1 they will want to try to preserve their muscle mass by doing resistance exercise (sometimes called strength-building exercise) and by focusing on having healthier foods including adequate protein and vegetables, and trying not to have carbonated drinks like soda or seltzer.

People who are already on a GLP-1 are not recommended to start another one at the same time. If they aren’t reaching their recovery goals, they can talk with a medical provider about other medications, such as naltrexone or acamprosate. They could also look into behavioral health options, such as mutual aid, peer support groups, therapeutic groups, or therapy.