What medications help with alcohol cravings?

From the Guidelines

Acamprosate is the most effective medication for helping with alcohol cravings, as it has been found to be better at maintaining alcohol abstinence than placebo, according to the most recent and highest quality study 1. When considering medication to help with alcohol cravings, it's essential to look at the most recent and reliable evidence.

Key Points to Consider

• The study published in the BMJ in 2020 1 found that acamprosate was the only intervention with enough high-quality evidence to conclude that it is better at maintaining alcohol abstinence than placebo.
• Other medications like naltrexone and disulfiram may also be considered, but the evidence for their effectiveness is not as strong as it is for acamprosate.
• The 2018 guidelines from the Journal of Hepatology 1 suggest that topiramate and baclofen may also be promising pharmacotherapies for alcoholism, but more research is needed to confirm their effectiveness.
• The 2010 study from Hepatology 1 found that naltrexone can help reduce the risk of relapse, but it also has the potential to cause hepatocellular injury.

Treatment Options

• Acamprosate (Campral): taken as 666mg three times daily, helps restore brain chemical balance disrupted by alcohol use.
• Naltrexone: typically prescribed at 50mg daily or as a monthly injection (Vivitrol), works by blocking opioid receptors in the brain, reducing the pleasurable effects of alcohol and decreasing cravings.
• Disulfiram (Antabuse): taken at 250-500mg daily, causes unpleasant reactions when alcohol is consumed, serving as a deterrent.
• Topiramate and gabapentin: sometimes prescribed off-label at gradually increasing doses, but more research is needed to confirm their effectiveness.

Important Considerations

• Medications work best when combined with counseling or therapy programs.
• Treatment typically continues for at least 3-6 months, often longer depending on individual needs.
• It's crucial to discuss options with a healthcare provider who can consider your specific situation, medical history, and other medications you may be taking before starting any of these treatments.

From the FDA Drug Label

Treatment of Alcoholism 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.

Naltrexone is used as an adjunctive treatment for alcoholism. The recommended dose is 50 mg once daily. It has been shown to support abstinence, prevent relapse, and decrease alcohol consumption in clinical studies 2.

• Key points:
  • Naltrexone is used to treat alcoholism
  • Recommended dose: 50 mg once daily
  • Used as an adjunct to social and psychotherapeutic methods
  • Shown to be effective in clinical studies 2, 2

From the Research

Medications for Alcohol Craving

• There are several medications approved by the U.S. Food and Drug Administration to treat alcohol use disorder, including acamprosate, disulfiram, and naltrexone 3.
• These medications have been shown to reduce alcohol consumption and increase abstinence rates, although the effects appear to be modest 3.
• Other medications, such as topiramate and gabapentin, may also be beneficial in reducing heavy alcohol use, although long-term studies are lacking 3.

Effectiveness of Medications

• Naltrexone has been shown to be effective in reducing drinking and craving for alcohol, particularly in individuals with high craving 4.
• Acamprosate and naltrexone have been evaluated in numerous clinical trials and represent evidence-based treatments for alcohol use disorders 5.
• Disulfiram has been used for years, but evidence supporting its effectiveness is inconsistent 3.

Off-Label Medications

• Off-label medications, such as baclofen, gabapentin, ondansetron, and topiramate, are commonly prescribed for the treatment of alcohol use disorder 6, 5.
• These medications may be useful in patients with comorbid conditions, such as nicotine dependence 6, 5.
• However, further studies are needed to fully understand the effectiveness of these medications for alcohol use disorder 6, 5.

Treatment Approaches

• The U.S. Preventive Services Task Force recommends that clinicians screen adults for alcohol misuse and provide brief behavioral counseling to reduce alcohol misuse 3.
• Pharmacotherapies, such as naltrexone and acamprosate, can be used in conjunction with behavioral counseling to treat alcohol use disorder 7.
• Current evidence does not support the use of pharmacogenetic testing for treatment individualization 7.