Medications for Alcohol Dependence


Naltrexone
(Depade, ReVia)


Action: Blocks opioid receptors, reducing craving and drinking responseContraindication: opioid use, acute opioid withdrawal, acute hepatitis, liver failureAdverse Reaction: precipitate severe withdrawal if opioid dependent; hepatotoxicityInteraction: opioid*Monitor liver function


Extended-Release Injectable Naltrexone
(Vivitrol)


Action: same (block opioid receptors, reducing cravings and response)C: Same (opioid); inadequate muscle mass for deep injection; rash/infection at inj siteAd Reaction: same (withdrawal for opioid); infection; depression; rare events (allergic pneumonia, suicidal ideation)Drug Interaction: opioids*Monitor liver function


Acamprosate
(Campral)


Action: glutamate & GABA neurotransmitter systemsC:renal impairmentAd Reaction: suicidal ideation and behaviorInteraction: none*Renal Function


Disulfiram
(Antabuse)


Action:Inhibits alcohol metabolism, causing acetaldehyde buildup and reaction of flushing, sweating, nausea, and tachycardia if alcohol is consumedC: alcohol or metronidazole use; CAD; severe myocardial disease; hypersensitivity to rubber (thiuram) derivativesAd Reaction: Disulfiram-alcohol reaction; hepatotoxicity; optic neuritis, peripheral neuropathy, psychotic reactionsDrug Interaction:*warfarin; any nonprescription drug containing alcohol*; isoniazid; metronidazole; phenytoin*First evaluate liver function, then monitor