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Pharmacotherapy for alcohol dependence

Table 6.2 Pharmacotherapy for alcohol dependence*



Medication features

Contra- indications



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




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.