Alcoholism

The following online article provides more information about four of the medications described below: Rawson RA, McCann MJ, Hasson L. Pharmacotherapies for Substance-Abuse Treatment. Counselor Magazine. October, 2000.


TOPIRIMATE
(Topomax)

What it does: An anticonvulsant, mood stabilizing medication that can help reduce alcohol cravings

How it works: Reduces brain levels of the neurotransmitter dopamine (which is believed to create the pleasurable sensations alcoholics get from drinking), potentially resetting the brain's chemistry

Side effects: Numbness and tingling in the hands and feet, difficulty concentrating, confusion, nervousness, headache, drowsiness and mood swings.
Special Alert: The FDA is notifying healthcare providers and patients with new data indicating an increased risk of cleft lip and/or cleft palate in infants exposed to topiramate (Topamax®) during pregnancy.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: In a 2008 study Topiramate was more effective than placebo in reducing body mass index, all liver enzyme levels, cholesterol levels, and systolic and diastolic blood pressure which might lower the risk of fatty liver degeneration and cirrhosis as well as heart disease. It significantly decreased obsessive thoughts and compulsions about using alcohol, increased participants’ well-being, and improved some aspects of quality of life, thereby lessening the risk of relapse.
Johnson BA, Rosenthal N, Capece JA, et al. Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Arch Intern Med. 168(11):1188-99, 2008.

For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a697012.html

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BACLOFEN (Lioresal or Gablofen®)

What it does: A muscle relaxant found to reduce alcohol cravings

How it works: Increases the amount of GABA, a neurotransmitter in the brain which has a relaxing effect

Side effects: Drowsiness, dizziness, weakness, upset stomach, confusion.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: Baclofen was effective in inducing abstinence from alcohol and reducing alcohol craving and consumption in alcoholics. This small study suggests that baclofen may be a potentially useful drug in the treatment of alcohol-dependent patients.
Addolorato G, Leggio L, Safety and efficacy of baclofen in the treatment of alcohol-dependent patients. Curr Pharm Des. 16(19):2113-7, 2010.

For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a682530.html

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NALTREXONE

What it does: Naltrexone is an opioid antagonist that can help reduce the desire for alcohol and lessen alcohol’s positive effects.

How it works: It blocks the parts of your brain that feel pleasure when you use alcohol. When these areas of the brain are blocked, you feel less need to drink alcohol, and may be able to stop drinking more easily.

Side effects: Nausea, headache, constipation, dizziness, anxiety and insomnia.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: Naltrexone has been shown to improve treatment outcomes in alcoholics when combined with treatments such as Alcoholics Anonymous meetings, addiction counseling, family therapy, group therapy, and hospital or residential treatment. However, adherence to daily oral doses has often been a problem.

Long-acting naltrexone injections may help with the problem of inconsistent use of the medication. In a clinical study conducted at 24 sites, once-a-month Naltrexone injections combined with psychotherapy significantly reduced heavy drinking in patients being treated for alcohol dependency within the first month of treatment, and this response was maintained over the six-month treatment period with few side effects.
Garbutt JC, Kranzler HR, O'Malley SS, et al. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial." JAMA. 293(13): 1617-1625, 2005.

For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a685041.html

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DISULFIRAM (Antabuse)

What it does: Antabuse has been in use since 1951. Studies show that it reduces the craving for alcohol and reduces the risk of relapse.

How it works: Antabuse causes unpleasant effects if you drink even small amounts of alcohol such as flushing, headache, nausea and vomiting. It begins to effect alcohol metabolism within 1-2 hours and reaches a peak in 12 hours. It is slowly excreted from the body over 2 weeks.

Side effects: Skin rash, headache, drowsiness, weakness, upset stomach, tiredness.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: In a systematic review six of eleven studies reported a significantly better effect on abstinence for patients treated with disulfiram, with patients having significantly more days until relapse and fewer drinking days.
Jørgensen CH, Pedersen B, Tønnesen H. The Efficacy of Disulfiram for the Treatment of Alcohol Use Disorder. Alcohol Clin Exp Res. 2011 May 25. [Epub ahead of print]

For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a682602.html

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CAMPRAL (Acamprosate)

What it is: This drug is widely used in Europe to reduce alcohol cravings in problem drinkers who have quit. It was approved by the FDA after studies showed that more participants who were given the drug stayed away from alcohol, compared with those who were given a placebo. However, Campral might not be effective for people who are currently drinking when they start taking the drug, or for those who are misusing other substances.

How it works: Campral reduces alcohol relapse by reducing the bad feelings that result when a person abstains. It works by stimulating GABA, a neurotransmitter transferring chemical messages between neurons in the brain. GABA can also be taken as part of amino acid therapy. (For more information on amino acid therapy see this chart on amino acids in the Holistic section of this web site.)

Side effects: Diarrhea, gas, upset stomach, loss of appetite, dry mouth, dizziness.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: A recent systematic review of 24 studies with 6,915 participants showed that acamprosate appears to be an effective and safe treatment in alcohol dependent patients for supporting continuous abstinence after detoxification from alcohol. When added to psychosocial treatment strategies, acamprosate reduced the risk of returning to any drinking after detoxification compared with treatment with a placebo. The cumulative abstinence time was also clearly increased.
Rösner S, Hackl-Herrwerth A, Leucht S, et al. Acamprosate for alcohol dependence. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004332.

For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a604028.html

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ONDANSETRON (Zofran)

What it is: Ondansetron is used to treat the nausea and vomiting caused by certain chemotherapies. It has been found to stop cravings, decrease alcohol consumption and increase abstinence in people who are early-onset alcoholics.

How it works: Ondansetron appears to work by acting on serotonin, one of the brain's many neurotransmitters. An imbalance between two chemical messengers in the brain, serotonin and dopamine, is believed to create a craving for alcohol. Ondansetron blocks a serotonin receptor, which decreases alcohol-induced dopamine release, resulting in a decrease in alcoholic-drinking behavior.

Side effects: Diarrhea, headache, constipation, weakness, dizziness, tiredness.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: A total of 271 patients with diagnosed alcoholism received treatment with ondansetron (1 microg/kg, 4 microg/kg, or 16 microg/kg twice a day) or placebo for 11 weeks plus group cognitive behavioral therapy. Patients with early-onset alcoholism taking ondansetron had fewer drinks per day. Ondansetron, 4 microg/kg twice per day, was better than placebo in increasing the percentage of days abstinent per week. Results suggest that ondansetron (particularly the 4 microg/kg twice per day dosage) is an effective treatment for patients with early-onset alcoholism.
Johnson BA, Roache JD, Javors MA, et al. Ondansetron for reduction of drinking among biologically predisposed alcoholic patients: A randomized controlled trial. JAMA. 284(8):963-71, 2000.

For more information: www.kap.samhsa.gov/products/manuals/tips/pdf/TIP49_LitRev.pdf

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CHANTIX (Zofran)

What it is: Chantix is a prescription medication that has generally been used for smoking cessation but has recently been studied as a viable option for treatment of alcohol dependence.

Availability: Physician prescription

Research: A 2013 study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that varenicline (marketed under the name Chantix), approved in 2006 to help people stop smoking, significantly reduced alcohol consumption and craving among people who are alcohol-dependent. The findings were published in the Journal of Addiction Medicine (ncbi.nlm.nih.gov/pubmed/23728065).

Two hundred men and women with alcohol dependence were recruited across 5 clinical sites. Patients received varenicline or placebo. Varenicline was titrated during the first week to 2 mg a day, which was maintained during weeks 2 to 13. The varenicline group had significantly lower weekly percent heavy drinking days, drinks per day, drinks per drinking day, and alcohol craving compared with the group who took a placebo. Adverse events were expected and mild. Varenicline significantly reduced alcohol consumption and craving, making it a potentially viable option for the treatment of alcohol dependence.

For more information on Chantix please see Varenicline on our nicotine medication page.

*Please note that FDA regulators have reported that a connection between Chantix and serious psychiatric problems including depression, agitation and suicidal behavior is "increasingly likely." A report from The Institute for Safe Medication Practices also linked Chantix to a wide array of health and safety problems. They include accidents and falls, potentially lethal heart rhythm disturbances, heart attacks, seizures, diabetes and various psychiatric disturbances.

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GABAPENTIN (Neurontin)

What it is: Gabapentin is a medication currently approved for treating seizures and nerve pain.

How it Works: Its activity in the GABA neurotransmitter pathway suggests it might alleviate alcohol craving, which is believed to involve GABA activation in a specific part of the brain (amygdala). Previous studies have shown that Gabapentin reduces this activity. This may increase rates of sustained abstinence and no heavy drinking and decrease alcohol-related insomnia and sad or anxious mood.

Side Effects: Can cause drowsiness, dizziness, headache, anxiety, constipation.
For a complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: In this 12-week study conducted from 2004-2010, 150 men and women with current alcohol dependence were given either gabapentin (900 mg or 1800 mg a day) or placebo. Gabapentin was associated with abstinence rates of 11.1% and 17% after 12 weeks in patients receiving 900 and 1,800 mg/day, respectively, compared with 4.1% for those in the placebo group. The no heavy drinking rate was 22.5% in the placebo group, 29.6% in the 900-mg group and 44.7% in the 1800-mg group of gabapentin. Gabapentin was effective in treating alcohol dependence and relapse-related symptoms of insomnia, sad or anxious mood, and craving. Patients reporting alcohol dependence were better able to stay sober and the medication produced no serious side effects.

Mason BJ, Quello S, Goodell V, et al. Gabapentin treatment for alcohol dependence: A randomized clinical trial. JAMA Intern Med. Published online November 4, 2013.