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cont. from
Drug Category: Opiate antagonists
Alcohol has been shown to bind to opiate receptors in the brain. Studies show
that blocking opiate receptors decreases cravings for alcohol.
|
Drug Name |
Naltrexone
(ReVia) -- Patients must be abstinent for 5-7 d before beginning
therapy. Monitor liver function during treatment. Expensive,
approximately $4.50/pill. Pure antagonist and is not addicting. |
| Adult Dose |
50 mg PO qd
Some physicians give 25 mg for the first 2 d of therapy; some believe
100 mg works better than 50 mg, but no trials demonstrate this |
| Pediatric Dose |
Not established |
| Contraindications |
Documented hypersensitivity, acute hepatitis, liver
failure |
| Interactions |
Inhibits effects of opiates; patients currently taking
opiates or who have been on long-term opiate therapy in previous 7 d can
experience severe opiate withdrawal |
| Pregnancy |
C - Safety for use during pregnancy has not been
established. |
| Precautions |
Nausea/vomiting, abdominal pain, daytime sleepiness,
and nasal congestion were more common vs placebo in largest randomized
trial to date; discontinuation due to adverse effects was uncommon in
most clinical trials. |
Drug Category: Glutamate receptor blockers
Mechanism of action is unknown, but it enhances GABA transmission and
inhibits glutamate transmission. Compared with placebo, reduces drinking
frequency and effectively increases abstinence in alcoholic patients.
| Drug Name |
Acamprosate (Campral) -- Synthetic compound with a chemical
structure similar to that of the endogenous amino acid homotaurine
(structural analogue of GABA). Mechanism of action to maintain alcohol
abstinence not completely understood. Hypothesized to interact with
glutamate and GABA neurotransmitters centrally to restore neuronal
excitation and inhibition balance. Not associated with tolerance or
dependence development. Use does not eliminate or diminish alcohol
withdrawal symptoms. Indicated to maintain alcohol abstinence as part of
a comprehensive management program that includes psychosocial support.
Available as a 333-mg tab. |
| Adult Dose |
666 mg PO tid; initiate as soon as possible after
alcohol withdrawal when abstinence has been achieved; if <60 kg, may
need to decrease dose by 333-666 mg/d
CrCl 30-50 mL/min: 333 mg PO tid |
| Pediatric Dose |
Not established |
| Contraindications |
Documented hypersensitivity; severe renal impairment (ie,
CrCl <30 mL/min) |
| Interactions |
Coadministration with naltrexone increases acamprosate
Cmax and AUC, but no dosage adjustment necessary |
| Pregnancy |
C - Safety for use during pregnancy has not been
established. |
| Precautions |
Diarrhea is most common adverse effect (20%), but
dropouts are few; additional common adverse effects are dizziness,
itching, nausea, flatulence, headache, and increased sexual desire;
depression and anxiety incidence slightly higher than that of placebo in
1 study |
Drug Category: Aldehyde dehydrogenase inhibitors
Disulfiram inhibits aldehyde dehydrogenase, and, as a result, acetaldehyde
accumulates. This leads to nausea, hypotension, and flushing if a person drinks
alcohol while taking disulfiram.
| Drug Name |
Disulfiram
(Antabuse) -- Decreases number of drinking days but does not
increase abstinence. Directly observed therapy might be more beneficial
but has not been studied in a good randomized trial. |
| Adult Dose |
250 mg PO qd |
| Pediatric Dose |
Not established |
| Contraindications |
Documented hypersensitivity, severe myocardial disease,
coronary occlusion |
| Interactions |
Do not administer with metronidazole; use with caution
in patients on phenytoin (levels of phenytoin might increase) |
| Pregnancy |
C - Safety for use during pregnancy has not been
established. |
| Precautions |
Adverse effects are uncommon, but hepatitis, optic
neuritis, neuropathy, and skin rash reported |
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