ALCOHOLISM

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, 1999--JW)
• 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. 61:905, 2004--AFP)

Others in the pipeline: Acamprosate