ACUTE ALCOHOL WITHDRAWAL
DIAGNOSIS OF ALCOHOLISM
Naltrexone (an opioid antagonist) for tx of alcoholism:
- Can cause hepatotoxicity (dose-dependent) and nausea,
headache, and dizziness
- 131 alcoholic adults w/stable living situations and >
5d of documented sobriety randomized to naltrexone
50mg/d vs. placebo (excluded if previously medicated for
detox, abnormal LFT's, or serious medical or psychiatric
comorbidities); all attended weekly cognitive-behavioral
therapy. At 12wks, naltrexone pts were sig. less likely
to have relapsed (40% vs. 64%) (Am. J. Psych. 156:1758,
- 627 pts with alcohol dependence randomized to naltrexone QD vs.
placebo. All received AA-based counseling; at 13wk and 1y f/u, no
sig. diff. in return to drinking or # of drinks per drinking day.
(NEJM 345:1734, 2001--JW)
Nalmefene (an opioid antagonist) for tx of alcoholism:
- No hepatotoxicity reported as of 2000
- In a randomized trial of 105 alcoholic pts, risk of
relapse over 12wk f/u sig. less with nalmefene vs.
placebo (Arch. gen. Psychiat. 56:719, 1999--AFP)
Ondansetron (an antiemetic) was ass'd with sig. reduced self-reported
drinking compared with placebo in a randomized trial in 271 alcoholics 25-65yo;
the benefit was limited to those pts with "early-onset" alcohlism
(onset at < 25yo) (JAMA 284:963, 2000--JW)
Topiramate can reduce cravings and improve abstinence (Arch. Gen. Psychiat.
Others in the pipeline: Acamprosate