Current Medications for Alcohol Use Disorder: A Comprehensive Review by Dr. Danish
Alcohol Use Disorder (AUD) is a complex condition that requires a multifaceted treatment approach. Among the most effective strategies are medications specifically designed to help individuals manage their dependence and support long-term recovery. This blog delves into the most current and evidence-based medications available for treating AUD, including the three FDA-approved options: disulfiram, acamprosate, and naltrexone. Additionally, we will explore other promising off-label medications that are gaining traction in the field.
To provide a comprehensive understanding, we will analyze four well-conducted studies that highlight the efficacy of these medications. These studies vary in their focus, with some measuring success through the reduction of alcohol cravings, while others evaluate the percentage of patients who achieve and maintain abstinence. By examining these diverse perspectives, we aim to offer a detailed and nuanced view of the pharmacological options available for treating AUD.
Breakdown of 4 Articles
Researchers conducted a comprehensive review to evaluate the effectiveness and safety of various medications for treating AUD. The study analyzed 156 randomized clinical trials involving 27,334 participants. Key findings include that acamprosate, disulfiram, baclofen, and oral naltrexone showed the most consistent evidence for improving abstinence and reducing heavy drinking. Specifically, Disulfiram is the most effective of all options, when taken properly; it reduces heavy drinking by 81%. Acamprosate (2-3 g/d) and oral naltrexone (50 mg/d) were effective in promoting total abstinence, with acamprosate improving abstinence by 33% and naltrexone by 15% over placebo. Baclofen (30 mg/d) also demonstrated significant efficacy, reducing heavy drinking by 28% compared to placebo.
The authors review existing and potential future medications for treating alcohol dependence. They highlight that no single effective therapy exists due to the complex nature of alcohol dependence. Currently, the FDA has approved acamprosate, disulfiram, and naltrexone, while the EMA also approves nalmefene. Emerging treatments include baclofen, topiramate, varenicline, and gabapentin, which show promise in reducing alcohol consumption and cravings. Additionally, psychoactive substances like psilocybin and MDMA are being explored for their potential to significantly reduce heavy drinking days.
This study conducted a comprehensive review and meta-analysis to evaluate the effectiveness of various medications in reducing alcohol consumption among individuals with AUDs. The study analyzed data from 32 randomized controlled trials involving 6,036 patients. The findings indicated that nalmefene, baclofen, and topiramate showed some efficacy in reducing total alcohol consumption (TAC) compared to placebo, with topiramate demonstrating the most significant reduction. Nalmefene and naltrexone were associated with higher rates of adverse events and withdrawals for safety reasons.
4. Pharmacological Treatment of Alcohol Cravings
Researchers conducted a systematic review to identify effective medications for reducing alcohol cravings and promoting abstinence in patients with AUD. The study found that Naltrexone and Acamprosate are the most effective drugs for reducing cravings and maintaining abstinence. Anticonvulsants like Gabapentin and Topiramate also demonstrated significant benefits. Baclofen showed promising results in reducing cravings and promoting abstinence. Varenicline, typically used for smoking cessation, was effective in reducing alcohol cravings. Other psychotropic drugs like Fluoxetine and Quetiapine also showed benefits in reducing cravings, with Quetiapine additionally promoting abstinence.
Medications for Alcohol Use Disorder (AUD)
1. Acamprosate (Campral)
Acamprosate is effective in treating Alcohol Use Disorder (AUD) by improving abstinence rates. Clinical trials indicate that it can enhance abstinence by 33% over placebo. The recommended dose is typically 2-3 grams per day, divided into three doses, and it can be taken with or without food. Common side effects include diarrhea, nausea, depression, and anxiety. Acamprosate is FDA-approved for alcohol use disorder and is supported by research demonstrating its ability to stabilize brain chemistry disrupted by chronic alcohol use.
Read more about Dr. Danish’s take on the dosing, efficacy, and potential side effects of Acamprosate here.
2. Disulfiram (Antabuse)
Disulfiram is used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol. It has been shown to reduce heavy drinking by 81% compared to placebo. The recommended dose ranges from 250-500 milligrams per day. Common side effects include drowsiness, headache, and a metallic taste, while more severe side effects, such as hepatotoxicity and a severe hypertensive crisis if alcohol is consumed, should be discussed with a healthcare provider. Disulfiram is FDA-approved for alcohol use disorder and is supported by research indicating its effectiveness in deterring alcohol consumption.
For more information, please visit Dr. Danish's blog here.
3. Baclofen (Lioresal)
Baclofen is FDA-approved for the treatment of muscle spasticity (such as in multiple sclerosis), but it is an off-label option for alcohol use disorder. It is approved for alcohol use disorders in other countries.
The article "Baclofen in the treatment of alcohol use disorder: tailored doses matter" highlights that tailored doses, ranging from 5 mg/day to 520 mg/day, usually divided into 2 doses (morning and evening) are crucial for effectiveness, with higher doses often necessary. Observational studies showed that 52.1% to 62% of patients achieved low-risk or abstinent drinking levels after one to three years.
Baclofen’s mechanism of action involves modulation of GABA-B receptors to reduce alcohol cravings and consumption.
Side effects vary; at lower doses, there is a low chance for mild dizziness and fatigue. However, high doses can lead to severe adverse effects such as mental confusion, mood disorders, and seizures, emphasizing the need for careful monitoring.
4. Naltrexone (ReVia, Vivitrol)
Naltrexone is effective in treating AUD by reducing cravings and promoting abstinence. Studies indicate it can improve abstinence rates by 15% over placebo. The recommended dose is 50 milligrams per day, and it can be taken with or without food. Common side effects include nausea, headache, dizziness, and fatigue. Naltrexone is FDA-approved for alcohol use disorder and is supported by research demonstrating its ability to block the euphoric effects of alcohol, thereby reducing the desire to drink.
For more information, please visit Dr. Danish's blog here.
4a. Low-Dose Naltrexone (LDN)
Low-Dose Naltrexone (LDN) refers to the use of naltrexone at doses significantly lower than the standard 50 mg, typically around 1 to 5 mg per day. At these lower doses, LDN is thought to modulate the immune system and reduce inflammation, offering potential benefits for conditions such as autoimmune diseases and chronic pain. LDN has been used off-label to help manage alcohol dependence by potentially reducing cravings and relapse rates. Common side effects include fatigue, headaches, and vivid dreams, which are usually temporary. The starting dose is often 1.5 mg daily, gradually increasing to a maximum of 4.5 mg based on individual response.
Read Dr. Danish’s blog here on the various benefits of LDN.
5. Nalmefene (Selincro)
Nalmefene has shown efficacy in reducing total alcohol consumption in patients with AUD. Clinical trials indicate it can significantly reduce alcohol intake. The recommended dose is 18 milligrams per day, taken as needed. Common side effects include nausea, dizziness, insomnia, and headache. Although not FDA-approved for alcohol use disorder, Nalmefene is supported by research indicating its potential to help patients reduce their alcohol consumption.
6. Topiramate (Topamax)
Topiramate has demonstrated significant efficacy in reducing total alcohol consumption in patients with alcohol use disorder (AUD), with clinical trials showing substantial reductions in drinking and recommended doses ranging from 200-300 milligrams per day in divided doses. Common side effects include paresthesia, weight loss, cognitive impairment, and dizziness. Although not FDA-approved for AUD, research supports its ability to reduce alcohol cravings and improve abstinence rates. In the study "An Intensive Longitudinal Examination of Topiramate Treatment for Alcohol Use Disorder," involving 164 participants over a 12-week period, topiramate significantly reduced the odds of heavy drinking by 74% compared to placebo and lowered levels of desire to drink and positive alcohol expectancies. The medication dosage ranged from 25 mg/day to a maximum of 200 mg/day, with some participants requiring dosage adjustments due to side effects. Importantly, the study found that the genetic marker rs2832407 did not influence the effectiveness of topiramate, suggesting its broad efficacy for individuals with AUD regardless of genetic makeup.
Read Dr. Danish’s blog here on the benefits, dosing, and potential side effects of topiramate.
7. Gabapentin (Neurontin)
Gabapentin has shown promise in treating AUD, with some clinical trials indicating it can reduce heavy drinking days and improve abstinence rates, especially in patients with a history of alcohol withdrawal symptoms. The recommended dose is typically 900-1800 milligrams per day, taken in divided doses, and it can be taken with or without food. Common side effects include dizziness, tiredness, and swelling, while more severe side effects should be discussed with a healthcare provider. While not FDA-approved for alcohol use disorder, Gabapentin is supported by research showing it can reduce alcohol cravings, improve sleep, lower anxiety, and enhance mood during early abstinence.
For more details, read Dr. Danish’s blog on Gabapentin.
8. Varenicline (Chantix)
Varenicline, typically used for smoking cessation, has shown effectiveness in reducing alcohol cravings in patients with AUD. Clinical trials indicate it can significantly reduce the desire to drink. The recommended dose is 1 milligram twice daily, taken with or without food. Common side effects include nausea, insomnia, abnormal dreams, and headache. Although not FDA-approved for alcohol use disorder, Varenicline is supported by research demonstrating its potential to help patients reduce their alcohol consumption and maintain abstinence.
Read Dr. Danish’s blog here on the benefits, dosing, and potential side effects of Chantix (varenicline).
Summary
The reviewed articles provide substantial evidence supporting the use of various medications for treating alcohol use disorder. While no single medication is universally effective, options like acamprosate, disulfiram, baclofen, and naltrexone show promise in improving abstinence and reducing heavy drinking.
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we continue to stay on top of the latest research related to alcohol use disorder so we can provide the best quality care in a safe manner. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for AUD or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
Learn about the benefits of Naltrexone and Vivitrol in treating alcohol use disorder.
Acamprosate is a usually well tolerated and viable treatment option to help cut down on alcohol use.
Discover how Disulfiram (Antabuse) can help stop drinking alcohol.
Find a variety of local and national outpatient and inpatient drug and alcohol treatment options tailored to individual needs.
LDN, or Low Dose Naltrexone, has some off-label evidence for alcohol use disorder.
Gabapentin is often used to help with anxiety, and there is growing evidence for its use in alcohol use disorder.
