From the Guidelines
Acamprosate is the most effective medication for maintaining alcohol abstinence, as evidenced by the highest quality study 1.
Medication Options for Alcohol Abuse
Several medications are effective for treating alcohol use disorder.
- Naltrexone (50mg daily oral or 380mg monthly injection) reduces alcohol cravings by blocking opioid receptors in the brain's reward pathway.
- Acamprosate (666mg three times daily) helps restore brain chemical balance disrupted by chronic alcohol use.
- Disulfiram (250-500mg daily) causes unpleasant reactions when alcohol is consumed, serving as a deterrent.
- Topiramate (up to 300mg daily, titrated slowly) and gabapentin (300-600mg three times daily) are sometimes used off-label to reduce cravings and withdrawal symptoms.
Treatment Considerations
These medications work best when combined with counseling or therapy.
- Treatment typically continues for at least 6-12 months, with some patients benefiting from longer durations.
- A healthcare provider should supervise medication selection based on individual factors like medical history, potential side effects, and treatment goals.
- Patients should be honest about their drinking patterns to receive appropriate care and should never stop these medications abruptly without medical guidance.
Recent Guidelines
The French Association for the Study of the Liver and the French Alcohol Society clinical guidelines recommend considering pharmacological treatment for promoting the maintenance of alcohol consumption targets (abstinence or reduced consumption) in dependent patients 1.
Liver Disease Considerations
In patients with alcoholic liver disease, acamprosate does not appear to be toxic to the liver and is probably safe, whereas disulfiram and naltrexone undergo hepatic metabolism and can cause liver damage 1.
Quality of Life
The primary goal of treatment is to improve quality of life by preventing liver disease progression and promoting long-term low or zero consumption targets 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%). A dose of 50 mg once daily is recommended for most patients
Naltrexone is a medication that can be used to treat alcohol abuse.
- The recommended dose is 50 mg once daily.
- Naltrexone has been shown to be effective in reducing drinking and preventing relapse in patients with alcohol dependence 2.
- It is recommended to use naltrexone as part of a comprehensive treatment plan that includes social and psychotherapeutic methods 2.
From the Research
Medications for Alcohol Abuse
The following medications have been approved by the US Food and Drug Administration (FDA) to treat alcohol dependence:
- Disulfiram
- Naltrexone
- Acamprosate 3, 4, 5, 6 In addition to these approved medications, researchers have identified new therapeutic targets and alternative medications are being evaluated for the treatment of alcohol use disorder (AUD) 3, 4, 5.
Off-Label Medications
Some off-label medications that are being used to treat AUD include:
- Nalmefene
- Varenicline
- Gabapentin
- Topiramate
- Baclofen
- Ondansetron
- Levetiracetam
- Quetiapine
- Aripiprazole
- Serotonin reuptake inhibitors 3, 4, 5 These medications have shown mixed results, with some showing good efficacy and mild to moderate side effects, while others have mixed or promising results but are awaiting findings from ongoing studies 3, 4, 5.
Efficacy of Medications
Studies have shown that:
- Acamprosate and naltrexone have been evaluated in numerous clinical trials and represent evidence-based treatments in AUDs 4, 7
- Naltrexone has been found to be slightly more efficacious in reducing heavy drinking and craving, while acamprosate has been found to be slightly more efficacious in promoting abstinence 7
- Topiramate, gabapentin, and varenicline have shown encouraging results and may be useful in patients with comorbid nicotine dependence 4, 5