Q.6 Alcohol use disorder

Q.6: 45 year old male with history of depression, seizure disorder, hepatitis and coronary artery disease. 
He is interested in medication options of his recent increase in alcohol craving and abuse. After detailed evaluation, he does meet criteria for alcohol use disorder, moderate.

– CBC (complete blood count) with Diff: normal.
– Liver function test: abnormal.
– Renal function test: normal.
– TSH: normal
– Urine drug screen: positive for cannabis.

Current Medications: Escitalopram, Metronidazole, Phenytoin and Methadone.

Which of the following is medication of choice for alcohol use disorder treatment in this patient?
(a) Naltrexone
(b) Acamprosate
(c) Disulfiram.


Answer: (b) Acamprosate


(1) Naltrexone is not indicated because:-

  • Contraindicated in patients with hepatitis and abnormal liver function tests.
  • Avoid in patients taking opioid medications for risk of opioid withdrawals.

(2) Disulfiram is not indicated because:-

  • Contraindicated to use with metronidazole
  • Avoid use in patients with coronary artery disease and seizure disorder
  • Risk of drug interactions with phenytoin.


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Dr. Harvinder Singh, M.D. (Admin)

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