From the Guidelines
Acamprosate, disulfiram, or naltrexone should be offered as part of treatment to reduce relapse in alcohol dependent patients. When considering treatment for alcoholism, it's essential to prioritize established medications with strong evidence for reducing relapse rates and improving quality of life. According to the most recent and highest quality study 1, pharmacological treatment is crucial for promoting the maintenance of alcohol consumption targets, and medications like disulfiram, acamprosate, naltrexone, nalmefen, and baclofen have received marketing authorization for the long-term treatment of alcohol dependence.
- The decision to use acamprosate, disulfiram, or naltrexone should be made taking into consideration patient preferences, motivation, and availability, as stated in 1.
- Brief motivational interventions should be routinely used in the medical management of alcohol use disorders, as recommended in 1.
- Patients with advanced alcoholic liver disease may require alternative treatments, such as baclofen, which has shown promise in preventing alcohol relapse 1.
- It's essential to note that while GLP-1 receptor agonists may have potential in reducing alcohol cravings, they are not currently FDA-approved for treating alcoholism and should not replace established treatments without further research and medical supervision.
From the FDA Drug Label
A dose of 50 mg once daily is recommended for most patients The placebo-controlled studies that demonstrated the efficacy of naltrexone hydrochloride as an adjunctive treatment of alcoholism used a dose regimen of naltrexone hydrochloride 50 mg once daily for up to 12 weeks.
The recommended dose of Naltrexone for the treatment of alcoholism is 50 mg once daily. This dose has been shown to be effective in placebo-controlled studies as an adjunctive treatment for alcoholism, and it is recommended for use for up to 12 weeks 2.
- Key points:
- Dose: 50 mg once daily
- Duration: up to 12 weeks
- Use: as an adjunctive treatment for alcoholism
From the Research
Good Laboratory Practices (GLP) for Alcoholism
There are no specific Good Laboratory Practices (GLP) mentioned in the provided studies for alcoholism. However, the studies discuss various treatments and medications for alcohol dependence.
Medications for Alcohol Dependence
- Naltrexone and acamprosate are two medications approved for the treatment of alcohol use disorder 3, 4, 5, 6, 7
- Disulfiram is also an approved medication for the treatment of alcohol use disorder 5
- Baclofen, a γ-aminobutyric acid B receptor agonist, has been used for the treatment of alcohol use disorder, although it is not FDA approved for this indication 5
Efficacy of Medications
- Acamprosate has been found to be slightly more efficacious in promoting abstinence, while naltrexone is slightly more efficacious in reducing heavy drinking and craving 4
- Naltrexone has been shown to have a larger effect size than acamprosate on the reduction of heavy drinking and craving 4
- The combination of naltrexone and acamprosate, with cognitive behavioral therapy, has been found to be superior to either medication alone for alcohol abstinence 7
Treatment Outcomes
- The COMBINE study found that medical management with placebo pills had a significant effect on the percentage of abstinent days, and naltrexone or additional behavioral therapy only had modest additional effects 3
- A meta-analysis found that acamprosate had a significantly larger effect size than naltrexone on the maintenance of abstinence, and naltrexone had a larger effect size than acamprosate on the reduction of heavy drinking and craving 4
- A study found that naltrexone patients attended significantly more group therapy sessions and had better outcomes compared to acamprosate patients 6