1. Naltrexone (Vivitrol)
Naltrexone (Vivitrol) is one of the first-line treatments for alcohol abuse disorder. Unlike other medications, you don’t need a detox program before taking naltrexone; you can start taking it even while you are still drinking.
How does naltrexone work?
Naltrexone works to suppress alcohol cravings by blocking the effects of natural opioids in your body. This reduces the reinforcing effects of alcohol.
Naltrexone can be taken two ways: as a tablet daily or as a once-monthly injection. Vivitrol (the brand-name injection) and naltrexone pills have never been compared in research studies, so we don’t know if one works better than other. Naltrexone cannot be used by people taking opioid medications.
Is naltrexone effective?
Sort of. In clinical studies, those taking naltrexone had a 17% lower risk of heavy drinking compared to those taking no medications. Naltrexone also decreased the number the drinking days by about 4%.
Naltrexone does cause some nausea and headache—though the longer you take it, the fewer side effects you will have. It is a first-line treatment (meaning it is tried before other medications), though as you will see below, it’s just as effective as topiramate.
2. Disulfiram (Antabuse)
Unlike naltrexone, disulfiram cannot be started while you are still drinking. In fact, it will make you quite sick if you take it with alcohol, which is sort of the point of it.
How does disulfiram work?
Disulfiram prevents alcohol from being fully metabolized, which causes nausea, vomiting headache and flushing if you drink alcohol while taking this medication.
Disulfiram is a pill taken at a dose of 500 mg per day for one to two weeks; then, the dose is lowered to 125 mg a day.
Is disulfiram effective?
Not really. A review of clinical studies on disulfiram did not find that the drug was any better than placebo. Disulfiram may work in a small subset of people who take it under supervised conditions.
3. Acamprosate (Campral)
Like disulfiram, acamprosate (Campral) should also be used once you’ve stopped drinking.
How does acamprosate work?
Acamprosate works by changing your brain chemistry to reduce your desire for alcohol. This medication comes as a pill; you’ll take two pills three times a day.
Is acamprosate effective?
In clinical studies, acamprosate showed mixed results and does not appear to have a significant effect on heavy drinking. In the studies where acamprosate was found to be effective, the drug reduced how often people returned to any drinking, and increased abstinence rates by 11%. Acamprosate is generally well-tolerated, which means patients experience few side effects while on it. However, diarrhea is the most common side effect reported.
4. Topiramate (Topamax)
Topiramate (Topamax) is used for migraine prevention, for seizure disorder, and to suppress appetite—and now for alcohol dependence. It can be used if you are still drinking.
How does topiramate work?
Topiramate works by altering the balance of chemicals in the brain, which reduces the rewarding effect of consuming alcohol. To take topiramate, you’ll increase your dose gradually over several weeks, starting at 25 mg per day and increasing to a maximum of 75 mg a day.
Is topiramate effective?
Yes. A review of several studies found that when topiramate was taken over 14 weeks, it reduced heavy drinking days compared to placebo. In addition, three clinical trials comparing naltrexone to topiramate found no difference in outcome, so both appear to be equally effective.
5. Baclofen (Lioresal)
Baclofen (Lioresal) is a muscle relaxant that has been found in small research studies to be effective in the treatment of alcohol dependence.
How does baclofen work?
Similar to some of the drugs above, baclofen reduces the rewarding feeling you get from consuming alcohol when you’re addicted. Baclofen is available as 10 mg tablets, and in studies, the effective dose was 10 mg three times daily (30 mg).
Is baclofen effective?
People taking baclofen for 12 weeks were more likely to be abstinent from alcohol compared to people taking no medication (71% of people versus 29% of people, respectively). Taken daily, baclofen may be effective for alcohol dependence. Baclofen is well-tolerated and has been around forever, so it is a tempting option.
Research suggests that the medications above need to be taken for two to six months, with at least six months being preferred by most experts. Be careful if and when you decide to stop these medications. While most do not need to be tapered before stopping all together, topiramate (Topamax) requires gradually cutting back on the dose over a few weeks before finally discontinuing it.
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