Pharmacotherapy for alcohol dependence
Table 6.2 Pharmacotherapy for alcohol dependence*
| Medication features | Contra- indications | Dose | Monitoring | Duration of therapy |
| Naltrexone (Revia) | ||||
| Opioid receptor antagonist
Decreases crav- ing for alcohol and minimizes relapse if it oc- curs | Acute hepa- titis or liver failure, cau- tion in cirrhosis
Opoid dependence | 25 mg × 3d
then 50 mg qd
may increase to max 150 mg qd | At high doses can cause reversible elevations in transaminases
Frequency of monitoring is determined by baseline levels** | 3 – 6 months*** |
| Acamprosate (Campral) | ||||
| Glutamate recep- tor modulator
Reduces symp- toms of post- acute withdrawal (e.g., insomnia, anxiety and rest- lessness) | Severe renal impairment | 666 mg tid | No labora- tory monitoring needed
Monitor for di- arrhea (a com- mon adverse effect) | Up to 1 year
Re-evaluate q3m |
| Disulfiram (Antabuse) | ||||
| If alcohol is con- sumed, causes toxic build-up of acetaldehyde by binding to acetaldehyde dehydrogenase
Potentially fatal reaction | Unstable angina, recent MI
Schizophrenia and other psy- chotic illness
Pregnancy
Severe cir- rhosis
Precautions with many diseases | 125 – 250 mg hs | Transaminases at baseline, 2 weeks then monthly × 3m | 3 – 6 months*** |
*Combination therapy no more effective than monotherapy.
** If < 1.5 × normal repeat monthly × three months, less frequently thereafter; if 1.5 – 3 × normal repeat in two weeks; if > 3 × normal or elevated bilirubin withhold medication and repeat in two weeks.
*** Treatment can be continued after six months if no adverse effects.