Alcohol dependence; Alcohol abuse
In the U.S., three drugs are specifically approved to treat alcohol dependence:
Naltrexone and acamprosate are categorized as anticraving drugs. Disulfiram is an aversion drug. Other types of medications, such as antidepressants, may also be used to treat patients with alcoholism.
Anticraving drugs are opioid antagonists. These drugs reduce the intoxicating effects of alcohol and the urge to drink.
Naltrexone. Naltrexone (ReVia, Vivitrol) is approved for the treatment of alcoholism and helps reduce alcohol dependence in the short term for people with moderate-to-severe alcohol dependency. ReVia, a pill that is taken daily by mouth, is the oral form of this medication. Vivitrol is a once-a-month injectable form of naltrexone.
Naltrexone should be prescribed along with psychotherapy or other supportive medical management. The most common side effects are nausea, vomiting, and stomach pain, which are usually mild and temporary. Other side effects include headache and fatigue. High doses can cause liver damage. The drug should not be given to anyone who has used narcotics within 7 - 10 days.
It is important that patients take the pill form of naltrexone (Revia) on a daily basis. Because many patients have difficulty sticking to this daily regimen, a monthly injection of Vivitrol may be an easier option. However, some patients suffer adverse injection-site reactions, including spreading skin infections and abscesses. Patients should monitor the injection site for pain, swelling, tenderness, bruising, or redness and contact their doctors if these symptoms do not improve within 2 weeks.
Naltrexone does not work in all patients. Some studies suggest that people with a specific genetic variant may respond better to the drug than those without the gene.
Research is being conducted on the effects of combining naltrexone with acamprosate (Campral), particularly for individuals who have not responded to single drug treatment.
Acamprosate. Acamprosate (Campral) is the newest drug to be approved for treatment of alcoholism. Acamprosate calms the brain and reduces cravings by inhibiting the transmission of the neurotransmitter gamma aminobutyric acid (GABA). Studies indicate that it reduces the frequency of drinking and, in concert with psychotherapy, improves quality of life even in patients with severe alcohol dependence. The drug may cause occasional diarrhea and headache. It also can impair certain memory functions but does not alter short-term working memory or mood. People with kidney problems should use acamprosate cautiously. For some patients, combination therapy with naltrexone or disulfiram may provide greater benefit than acamprosate alone.
Disulfiram. Some drugs have properties that interact with alcohol to produce distressing side effects. Disulfiram (Antabuse) causes flushing, headache, nausea, and vomiting if a person drinks alcohol while taking the drug. The symptoms can be triggered after drinking half a glass of wine or half a shot of liquor and may last from half an hour to 2 hours, depending on dosage of the drug and the amount of alcohol consumed. One dose of disulfiram is usually effective for 1 - 2 weeks. Overdose can be dangerous, causing low blood pressure, chest pain, shortness of breath, and even death. The drug is more effective if patients have family or social support, including AA "buddies," who are close by and vigilant to ensure that they take it.
Topiramate. Topiramate (Topamax) is an anti-seizure drug used to treat epilepsy. It also helps control impulsivity. Studies indicate it may be a promising treatment for alcohol dependence. In one well-designed study, patients who took topirimate had fewer heavy drinking days, fewer drinks per day, and more continuous days of abstinence than patients who received placebo. Side effects included burning and itching skin sensations, change in taste sensation, loss of appetite, and difficulty concentrating.
Baclofen. Baclofen (Lioresal) is a muscle relaxant and antispasmodic drug. It is being investigated for its benefits in helping maintain abstinence, particularly in patients with alcoholic cirrhosis.
Addolorato G, Leggio L, Ferrulli A, Cardone S, Vonghia L, Mirijello A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet. 2007 Dec 8;370(9603):1915-22.
Anton RF. Naltrexone for the management of alcohol dependence. N Engl J Med. 2008 Aug 14;359(7):715-21.
Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006 May 3;295(17):2003-17.
de Roux A, Cavalcanti M, Marcos MA, Garcia E, Ewig S, Mensa J, et al. Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia. Chest. 2006 May;129(5):1219-25.
Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med. 2006 Jul;160(7):739-46.
Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, et al. Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Arch Intern Med. 2008 Jun 9;168(11):1188-99.
Johnson C, Drgon T, Liu QR, Walther D, Edenberg H, Rice J, et al. Pooled association genome scanning for alcohol dependence using 104,268 SNPs: Validation and use to identify alcoholism vulnerability loci in unrelated individuals from the collaborative study on the genetics of alcoholism. Am J Med Genet B Neuropsychiatr Genet. 2006 Aug 7; [Epub ahead of print]
Kleber HD, Weiss RD, Anton RF Jr, George TP, Greenfield SF, Kosten TR, et al. Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry. 2007 Apr;164(4 Suppl):5-123.
McKenna W. Diseases of the myocardium and endocardium. In: Goldman L and Ausiello DA, eds. Cecil Medicine. 23rd edition. Philadelphia, PA: Saunders Elsevier; 2007: chap 59.
O'Connor PG. Alcohol abuse and dependence. In: Goldman L and Ausiello DA, eds. Cecil Medicine. 23rd edition. Philadelphia, PA: Saunders Elsevier; 2007: chap 31.
Volkow ND, Wang GJ, Begleiter H, Porjesz B, Fowler JS, Telang F, et al. High levels of dopamine D2 receptors in unaffected members of alcoholic families: possible protective factors. Arch Gen Psychiatry. 2006 Sep;63(9):999-1008.
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