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Medications to Reduce Alcohol Use: Naltrexone and Acamprosate

Page history last edited by Eileen Barrett 1 year, 1 month ago

Alcohol Cessation: Counseling and Medications

 

  • Alcohol use disorders are common in NM and exact a heavy burden of disease
  • Population-based and clinician-based interventions can reduce complications from alcohol use disorders
  • UNM hospitalists can reduce the burden of disease through:
    • Providing screening and brief counseling (such as via SBIRT)
    • Prescribing medications such as naltrexone and acamprosate
    • Offering contraception to women of childbearing age (such as DepoProvera & referral to GYN for an IUD, or start an OCP)

 

Medications to Reduce Return to Drinking

 

Naltrexone

 

  • First line treatment
  • Dosing: 25mg daily for 7 days, then 50mg daily
  • Generic!
  • Indicated to reduce cravings, decrease heavy drinking days, increases ability to abstain
  • Contraindications: severe liver disease (AST, ALT, or GGT >6x ULN), chronic opioid use (because the patient will need a higher dose of opioids, as this is a mu receptor antagonist)
  • Side effects: nausea (which is reduced by the half-dose for one week regimen, as above)
  • Directions to PCP: check LFTs q1-3 months
  • Provide a one month supply with directions in your DC summary that this is commonly continued for at least 3 months and then the patient and their PCP can reassess

 

Acamprosate

 

  • Second line to naltrexone
  • Dosing: 666mg TID
  • Generic!
  • Indicated to prolong abstinence, reduce heavy drinking
  • Contraindications: suicidality, CKD (CrCl <30)
  • Side effects: diarrhea (common), suicidality (rare but serious)
  • Directions to PCP: monitor renal function, mood
  • Provide a one month supply with directions in your DC summary that this is commonly continued for at least 3 months and then the patient and their PCP can reassess

 

References

  • Kranzler HR, Soyka M. Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA. 2018 Aug 28;320(8):815-824. doi: 10.1001/jama.2018.11406. Review. PMID: 30167705. Journal Article Link
  • Fuster D, Samet JH. Alcohol Use in Patients with Chronic Liver Disease. NEJM. 2018 Sep 27;379(13):1251-1261. doi: 10.1056/NEJMra1715733. PMID: 30257164. Journal Article Link
  • Reus VI et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry 2018 Jan 1; 175:86. (https://doi.org/10.1176/appi.ajp.2017.1750101)
  • American Psychiatric Association. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder American Psychiatric Association Publishing; 2018. (https://psychiatryonline.org/doi/full/10.5555/appi.books.9781615371969.alcohol00pre)

Comments (1)

Kendall Rogers said

at 10:45 am on Feb 24, 2018

Given the new NEJM guidelines for management of alcoholic liver disease, should we make baclofen the second line agent for cessation in alcoholic liver disease?

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