When do you recommend acamprosate vs naltrexone for medication-assisted therapy in alcohol use disorder?  

Most addiction doctors use naltrexone as the first-line treatment due to its mixed but overall supportive evidence and easier adherence with once-a-day or once-a-month dosing. Acamprosate, on the other hand, comes in large pills, 2 tablets TID (6 tablets is a lot for some patients), making it challe...

I would suggest starting naltrexone for about a week and then transitioning to Vivitrol shots. Continue Vivitrol every four weeks as a maintenance treatment regardless of drinking levels. I would also recommend at the start of the treatment, getting some baseline labs to include a CBC, comprehensive...

I usually start with naltrexone and have had good results with it. Taking medication three times a day is challenging for many people.

For my patients with moderate to severe chronic alcohol abuse disorder, they are wanting to cut down or stop their excessive alcohol consumption, I explain the benefits of a daily pill, which can also be administered as a once-monthly injection at a local clinic. Most tend to opt for the daily pill...

I would recommend acamprosate over naltrexone for the following patients: Patients with moderate to severe hepatic impairment (LFT >5 times the upper normal limits). Patients whose treatment goal is abstinence and who can stop drinking for 4-5 days before initiation of treatment. Patients wh...

I usually start with naltrexone and will move to topiramate if not tolerated or contraindicated. I feel topiramate is underutilized for alcohol use disorder. I don't use acamprosate very often because of the frequent dosing.

Clinically, patients with PTSD tend to do well with acamprosate 666 mg, three times a day for alcohol dependence that began or was perpetuated by recent trauma triggers (i.e., in the military setting). Naltrexone is good for augmenting the craving but due to the cost and risk of polypharm, I stick t...

What would your treatment be for someone who has been on monthly visits for Suboxone and came into our program but discovered that he is using methamphetamine regularly?

Agree with all of the above. It does seem to be a good add-on to naltrexone.