Alcohol Use Disorder Treatments

Summary

Several medications are used to treat alcohol use disorder, including disulfiram, acamprosate, and naltrexone.

Disulfiram, also known as Antabuse, works by blocking the enzyme acetaldehyde dehydrogenase or ALDH. This causes a buildup of the toxic metabolite acetaldehyde whenever alcohol is consumed. Patients taking disulfiram should avoid alcohol, but when alcohol is consumed it can cause an unpleasant reaction that includes nausea and vomiting, respiratory distress, tachycardia, sweating, headache, hypotension, and facial flushing. Importantly, patients should continue to abstain from alcohol for 2 weeks after stopping the drug.

Acamprosate, also known as Campral, is another medication for alcohol use disorder. It works by reducing alcohol withdrawal symptoms such as anxiety. Acamprosate is contraindicated in patients with renal failure.

Naltrexone is an opioid blocking drug that is also used to treat alcohol use disorder. It works to reduce alcohol cravings by blocking the pleasurable effects of alcohol. Notably, naltrexone is contraindicated in patients with liver failure.

Key Points

• Alcohol Use Disorder Treatments
  • Disulfiram (Antabuse)
    • Blocks acetaldehyde dehydrogenase
    • Causes severe reaction to alcohol
      • Nausea/vomiting
      • Facial flushing
      • Sweating
      • Headache
      • Tachycardia
      • Hypotension
      • Respiratory distress
    • Avoid alcohol
      • Including any products that may contain alcohol, including hand sanitizer, aftershave lotion, cologne, mouthwash, cough medicine, vinegar, vanilla extract, and paint
      • Instruct patient to carefully read labels of all products to check for alcohol content
      • Continue alcohol avoidance for 2 weeks after discontinuation
        • The medication can last in the body for up to 2 weeks following the last dose
  • Acamprosate (Campral)
    • Reduces withdrawal effects
      • Reduces anxiety & restlessness
    • Contraindicated in renal failure
  • Naltrexone (ReVia)
    • Reduces cravings
      • Takes away the “high” pleasurable feeling, leaving the patient with less desire to drink alcohol
    • Avoid in liver failure