What medication is suitable for a patient with excessive alcohol consumption?

From the Guidelines

Acamprosate is the most recommended medication for patients with excessive alcohol consumption, as it has the highest quality evidence for maintaining abstinence. Several medications can help patients with excessive alcohol consumption, including naltrexone, disulfiram, and acamprosate 1.

Medication Options

• Naltrexone (50mg daily) reduces alcohol cravings by blocking opioid receptors in the brain, decreasing the pleasurable effects of alcohol.
• Acamprosate (666mg three times daily) helps restore brain chemical balance disrupted by chronic alcohol use and works best for maintaining abstinence.
• Disulfiram (250-500mg daily) causes unpleasant reactions when alcohol is consumed by blocking alcohol metabolism, serving as a deterrent.

Treatment Approach

For patients experiencing withdrawal, benzodiazepines like diazepam or lorazepam may be needed initially under medical supervision 1. These medications work best when combined with counseling or behavioral therapy. Treatment duration typically ranges from 3-12 months but may continue longer based on individual needs. Patients should be monitored for side effects and medication adherence, with regular follow-up appointments to assess progress and adjust treatment as needed 1.

Key Considerations

Acamprosate has been found to be the only intervention with enough high-quality evidence to conclude that it is better at maintaining alcohol abstinence than placebo 1. The decision to use acamprosate, disulfiram, or naltrexone should be made taking into consideration patient preferences, motivation, and availability 1.

From the FDA Drug Label

The efficacy of naltrexone hydrochloride as an aid to the treatment of alcoholism was tested in placebo-controlled, outpatient, double blind trials. In one of these studies, 104 alcohol-dependent patients were randomized to receive either naltrexone hydrochloride tablets 50 mg once daily or placebo. In this study, naltrexone hydrochloride proved superior to placebo in measures of drinking including abstention rates (51% vs 23%), number of drinking days, and relapse (31% vs. 60%). The clinical use of naltrexone hydrochloride as adjunctive pharmacotherapy for the treatment of alcoholism was also evaluated in a multicenter safety study. Results of this study demonstrated that the side effect profile of naltrexone hydrochloride appears to be similar in both alcoholic and opioid dependent populations, and that serious side effects are uncommon. In the clinical studies, treatment with naltrexone hydrochloride supported abstinence, prevented relapse and decreased alcohol consumption

Naltrexone is a suitable medication for a patient with excessive alcohol consumption, as it has been shown to support abstinence, prevent relapse, and decrease alcohol consumption in clinical studies 2.

• Key benefits of naltrexone include:
  • Reduced abstention rates
  • Decreased number of drinking days
  • Lower relapse rates
• Important consideration: Naltrexone is most effective when used as part of a comprehensive treatment program that includes social and psychotherapeutic methods.

From the Research

Medication Options for Excessive Alcohol Consumption

• Disulfiram, naltrexone, and acamprosate are approved by the US Food and Drug Administration (FDA) for the treatment of alcohol use disorder 3.
• Naltrexone and disulfiram have been shown to be safe and effective in patients with alcohol dependence and comorbid psychiatric disorders, such as major depression 4, 5.
• Acamprosate and naltrexone have been evaluated in numerous clinical trials and represent evidence-based treatments in alcohol use disorders 6.
• Other medications, such as topiramate, gabapentin, and varenicline, may be useful in treating alcohol use disorder, but more research is needed to fully understand their effectiveness 6.

Treatment Approaches

• Patients who are not alcohol-dependent may opt to reduce drinking to lower risk levels 7.
• Patients with alcohol dependence should receive pharmacotherapy and brief behavioral support, as well as disease management for chronic relapsing dependence 7.
• Supervised disulfiram is a second-line treatment approach 6.
• Combination therapy with disulfiram and naltrexone may not provide an advantage over single medication therapy 4, 5.

Important Considerations

• Medication compliance is crucial for effective treatment, and can be evaluated using systems such as the Microelectric Events Monitoring System 5.
• Patients with alcohol dependence should be encouraged to participate in community support groups 7.
• Further studies are needed to fully understand the effectiveness of various medications and treatment approaches for alcohol use disorder 6.