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

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...

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...

First, I dislike the term, "medication-assisted therapy". It gives me the impression the medication is "assisting" with other care and treatment. For my patients, medications ARE the foundational treatment, as with so many other general medical conditions. It tends to reinforce that they have a bona...

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

I would recommend acamprosate over naltrexone for the following patients:

1. Patients with moderate to severe hepatic impairment (LFT >5 times the upper normal limits).
2. Patients whose treatment goal is abstinence and who can stop drinking for 4-5 days before initiation of treatment.
3. Patients who do no...

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...

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

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?

I generally do not see why we should use "acamprosate versus naltrexone" and not one or the other or both at the same time. It all depends on the need of the patient; the reasoning that they have for drinking or stopping drinking, and the mechanism of action is different and complementary notwithsta...