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

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 (Selincro)

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 (Campral)

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 (Antabuse)

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:

  • Nausea

  • Chest pain

  • Vomiting

  • Dizziness

In addition to alcoholic drinks, products that may contain alcohol include:

  • Aftershave

  • Mouthwash

  • Some types of vinegar

  • Perfume

You should also try to avoid substances that give off alcoholic fumes, such as paint thinners and solvents.

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