Medications for Alcohol Use Disorder Treatment

Medications for Alcohol Use Disorder Treatment

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NALTREXONE

ACAMPROSATE

DISULFIRAM

MECHANISM OF ACTION

Blocks mu opioid receptors, which reduces reinforcing effects of alcohol with resultant decreased feelings of intoxication & less craving

Blocks glutaminergic NMDA receptors & activates 3-Amino butyric acid type A receptors

Blocks acetaldehyde dehydrogenase causing buildup of acetaldehyde with resultant nausea, flushing & tachycardia

CONTRA- INDICATIONS

– Long term opioid therapy or heroin use disorder

– Hepatitis or liver failure

(*check LFT monthly X 3months then Q3monthly)

– Severe renal impairment (Cr Cl < 30 mL/min)

Note: dose adjustment needed in Cr Cl 30-50 mL/min.

– Concomitant use of alcohol or alcohol containing prep or Metronidazole.

– Psychosis, coronary artery ds, severe myocardial disease.

– Not recommended in: Seizure, Peripheral neuropathy, Cirrhosis with portal hypertension.

SIDE EFFECTS

– well tolerated

– Nausea (most common s/e), headache, anxiety, sedation

– well tolerated

– transient diarrhea (most common s/e)

Disulfiram-Alcohol reaction, metallic taste, dermatitis, hepatotoxicity, peripheral neuropathy, psychosis, optic neuritis.

PREGNANCY

FDA Category C

FDA Category C

FDA Category C

BREAST FEEDING

Transfer of naltrexone and 6ß-naltrexol into human milk has been reported with oral naltrexone.

not known whether

acamprosate is excreted in human milk

Do not give disulfiram to nursing mothers.

DRUG INTERACTIONS

Opioid medications

no clinically relevant interactions

warfarin, isoniazid, metronidazole, phenytoin, any non prescription drug contianing alcohol.

ADULT DOSE

– 50 mg/day in single dose.

– Patient should be opioid free for minimum of 7-10 days.

– Naloxone challenge test should be employed in at risk patient.

– Monitor LFTs

– 333 mg #2 (666 mg) TID

– 333 mg # 1 daily for Cr Cl 30-50 mL/min.

– Monitor Renal function

– 250 mg/day (max 500 mg/day)

– Not to take Disulfiram for at least 12 hour after drinking alcohol

– Alcohol-Disulfiram reaction can occur put 2 weeks after last dose

SourceSAMHSA, HHS Publication No. (SMA) 15-4907

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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