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.

Topiramate

Topiramate is a type of anti-seizure medication that is commonly used to treat epilepsy but is now also being prescribed as part of alcohol use disorder treatment. Also known as Topamax, research has shown that it can reduce cravings by interacting with GABA and decreasing dopamine levels (which is associated with alcohol consumption).

Over time, this can reduce the rewarding effects of alcohol, thereby lessening the desire to drink. As a result, Topiramate is often used to counteract heavy drinking.

Baclofen

Baclofen is a muscle relaxer that is prescribed for conditions such as multiple sclerosis and spinal cord injuries. Baclofen can also be taken to treat alcohol use disorders when prescribed under the supervision of a physician. However, the efficacy of Baclofen for long-term treatment is debated.

It’s important to note that heavy drinking is strongly advised against if you are taking Baclofen. While alcohol withdrawal symptoms can be alleviated by taking Baclofen, combining alcohol and this medication can have detrimental effects on your health, including:

Overdose and death
Impaired motor functions
Extreme sedation
and more...

Benzodiazepines

Benzodiazepines, also referred to as ‘Benzos’, are a class of medications that are commonly used for treating alcohol withdrawal symptoms. Benzodiazepines can either be short-acting or long-acting (remains in the bloodstream for longer), depending on the type of Benzodiazepine that is administered. The most common types of Benzos for treating alcohol withdrawal are Diazepam (Valium), Lorazepam (Ativan), and Chlordiazepoxide (Librium).

Alcohol withdrawal symptoms can be managed through taking Benzos, relaxing the patient by depressing the central nervous system. Withdrawal symptoms that can be alleviated or reduced include:

Nausea
Seizures/tremors
Insomnia and restlessness
Irritability
Anxiety

Vivitrol

Vivitrol is a brand-name Naltrexone medication that can be used for treating alcohol dependence. Patients must stop drinking in preparation for starting and while using Vivitrol. As it contains Naltrexone, Vivitrol acts as an opioid antagonist, decreasing cravings and reducing the likelihood of relapse after treatment.

Vivitrol is administered via an intramuscular injection, usually of the buttock. This is done every 4 weeks. Alternatively, it can also be taken orally as a tablet or pill. Vivitrol binds to the opioid receptors in the brain, preventing them from being stimulated by alcohol.

Like most medications for alcohol use disorder, Vivitrol is used in conjunction with other treatment methods, such as psychotherapeutic modalities and counselling.

How could The OAD Clinic Help me?

At The OAD Clinic, we offer a number of treatment programmes for those who are looking to quit drinking. As healthcare professionals, we can adequately support and guide you through your treatment regime. Our treatment programmes include:

Alcohol Detox – completely flush alcohol from your body, also known as going ‘cold turkey’ under clinical supervision.
Home Alcohol Detox – detox from the comfort of your own home with at-home support and care.
Stop Drinking Programme – a (up to) 3-month programme that can be tailored to your needs, empowering participants with practical tips and knowledge on how to successfully stop drinking.
Controlled Drinking Programme – a 20-hour outpatient programme which can be delivered online or in-person, helping participants better understand their dependence and nature of uncontrolled drinking.
Post treatment Alcohol Aversion Programmes – a remote monitoring programme designed for relapse prevention, assisting with long-term recovery.

There are many medications that could be used as part of your alcohol dependence treatment plan. From Naltrexone to Benzodiazepines, our medical staff will support you in finding the right medication for your needs alongside various therapies and counselling sessions where needed.

Embark on your journey to sobriety with The OAD Clinic.