Alcohol Use Disorder: Pharmacologic Treatment Options.(BONUS DIGITAL CONTENT: FPIN's Clinical Inquiries)

• Published in: American family physician Vol. 102; no. 7; pp. 440 - 440A
• Main Authors: Groves, Cynthia, Griffin, Leslie, Bradford, J. Lacie, Auten, Beth
• Format: Journal Article
• Language: English
• Published: Leawood American Academy of Family Physicians 01-10-2020
• Subjects: Acamprosate; Alcohol use; Analysis; Care and treatment; Drinking of alcoholic beverages; Evidence-based medicine; Substance abuse
• ISSN: 0002-838X

Evidence Summary A 2014 meta-analysis of 22 RCTs and one cohort study (N = 22,803) evaluated relapse rates in patients who received acamprosate or naltrexone, alone or in combination, for at least 12 weeks.1 The primary outcome was a return to alcohol consumption, classified as any or heavy consumption (at least five drinks per day for men or at least four for women). A 2004 RCT examined the effectiveness of naltrexone or acamprosate, alone or in combination, in preventing relapse in newly detoxified adults (N = 160).2 Table 1 shows relapse rates at 12 and 24 weeks among the four treatment groups.2 Acamprosate, naltrexone, and combination therapy were significantly more effective than placebo at 12 and 24 weeks (P < .05). Recommendations from Others The American Psychiatric Association (APA) and the National Institute for Health and Care Excellence recommend naltrexone and acamprosate as the preferred pharmacologic options for patients with alcohol use disorder, in combination with cognitive behavioral interventions.3,4 The APA recommends against acamprosate therapy in patients with severe renal impairment, and against naltrexone in those with hepatic failure or acute hepatitis.3 Acamprosate is typically taken three times daily; naltrexone is taken once daily and is also available in a long-acting parenteral formulation.