Medications for Treating Alcohol Dependence
There are several medications that we can prescribe for alcohol dependence. Some of these are Relapse Prevention Medications (Naltrexone, Nalmefene, Acamprosate), and others for Achieving & Maintaining Abstinence (Disulfiram).
Naltrexone is an opioid receptor antagonist approved for use in the treatment of alcohol dependence in conjunction with psychosocial interventions. It is believed that Naltrexone works by blocking opioid receptors, which reduces the reinforcing effects of alcohol leading to decreased feelings of intoxication and fewer cravings.
Long-term opioid therapy for chronic pain or heroin dependence is a contraindication for
Naltrexone because the drug could precipitate severe withdrawal syndrome. Naltrexone
has been shown to have dose-related hepatotoxicity, although generally this occurs at
doses higher than those recommended for treatment of alcohol dependence. The drug
is also contraindicated in patients with hepatitis or liver failure. All patients should
have hepatic transaminase levels checked monthly for the first three months and every
three months thereafter.
Before being prescribed any of these medications, you'll have a full medical assessment, including blood tests.
Naltrexone is generally well tolerated, being nausea the most common adverse effect (reported by 10% of patients), followed by headache, anxiety and sedation. The recommended dosage of Naltrexone is 50 mg per day in a single dose.
Nalmefene may be used to prevent a relapse or limit the amount of alcohol
someone drinks. It works by blocking opioid receptors in the brain, which
reduces cravings for alcohol. Nalmefene may be recommended as a possible
treatment for alcohol dependence if you've had an initial assessment and:
You don't have any physical withdrawal symptoms
You don't need to stop drinking immediately or achieve total abstinence
You're still drinking more than 7.5 units a day (for men) or more than 5 units a day (for women)
Nalmefene should only be taken if you're receiving support to help you reduce your alcohol intake and continue treatment. The recommended dose is one tablet on days when you think there is a risk you will drink alcohol. Maximum dose is one tablet per day. You should take the tablet 1-2 hours before you start drinking alcohol. Swallow the tablet whole, do not crush or divide the tablet.
Acamprosate is used to help prevent a relapse in people who have successfully
achieved abstinence from alcohol. It's usually used in combination with
counselling to reduce alcohol craving. It works by affecting levels of a chemical
in the brain called gamma-amino-butyric acid (GABA).
GABA is thought to be partly responsible for inducing a craving for alcohol.
If you're prescribed acamprosate, the course usually starts as soon as you begin
withdrawal from alcohol and can last for up to six months. The usual dose is
two tabs (333 mg) three times per day.
Disulfiram can be used to achieve abstinence but when there are concerns that you may relapse, or if you've had previous relapses. Disulfiram works by deterring patients from drinking by causing unpleasant physical reactions if they drink alcohol. These include:
In addition to alcoholic drinks, products that may contain alcohol include:
Some types of vinegar
You should also try to avoid substances that give off alcoholic fumes, such as paint thinners and solvents.