Rx Options for Cutting Alcohol Cravings

Alcohol abuse medications acamprosate and naltrexone reduced alcohol cravings and consumption

(RxWiki News) Alcohol abuse can take a toll on your physical and mental health. A fraction of those who abuse alcohol get treated, and fewer still are believed to receive medication that might help.

In a new study, two recently developed medications, acamprosate (Campral) and naltrexone (Vivitrol, Revia, Depade), proved to be equally effective at curbing alcohol cravings and consumption. The injected form of naltrexone reduced the amount of heavy drinking among those who completed in-patient treatment programs.

An older medication called disulfiram (Antabuse), has been used since the 1950s, but disulfiram may not be as effective as the newer medications, the researchers wrote.

"Seek your doctor's help to reduce the amount of alcohol you drink."

Daniel Jonas, MD, MPH, of the University of North Carolina School of Medicine in Chapel Hill, NC, was this study’s lead author.

Dr. Jonas and his team of researchers analyzed 122 clinical trials enrolling a total of 22,803 persons in in-patient alcohol abuse treatment programs. These participants were given, among other medications, either acamprosate or naltrexone to determine which would best curb alcohol consumption and cravings. The trials were conducted from January 1970 through October 2013 and lasted from 12 weeks to 52 weeks.

A total of 27 of those clinical trials involved testing the effects of acamprosate on 7,519 patients, and 53 of the trials involved testing the effects of naltrexone on 9,140 patients. The largest trial, involving 1,383 patients, compared the effects of taking either of those two medications to the effects of taking a placebo containing no medication.

Sixty-nine other trials also compared prescription pharmaceuticals to placebos, including four trials testing the effects of disulfiram, the medications first used in the 1950s and still prescribed by many doctors. Several of the trials involved alternating use of acamprosate and naltrexone to compare the effects of those separate medications on patients.

Dr. Jonas and colleagues concluded that both acamprosate or naltrexone in pill form helped to curb alcohol consumption but that neither medication worked better than the other to achieve that goal.

Naltrexone that was injected resulted in patients having a decrease in the number of days each month that they drank heavily. Heavy drinking was defined as four or more drinks per day for women and five or more for men.

Also, the researchers wrote that taking 50 milligrams per day of acamprosate or naltrexone was most effective in reducing alcohol consumption when patients also were undergoing counseling.

As a further measure of the medications' effectiveness, these researchers concluded that of every 12 persons taking acamprosate, one succeeded at stopping drinking entirely. Of every 20 persons taking naltrexone pills, one stopped drinking entirely. 

For every 12 persons taking naltrexone in pill form, one stopped drinking heavily.

In addition, there was “moderate evidence,” the researchers wrote, that two medications approved by the US Food and Drug Administration (FDA) for uses other than treatment of alcohol abuse helped reduce alcohol consumption. Those medications were nalmefene (Revex) and topiramate (Topamax).

Patients taking nalmefene and topiramate both experienced a decline in the number of days during which they drank heavily as well as a decline in drinking days overall. 

Because it has been available since the 1950s, disulfiram may be more familiar to many doctors than naltrexone or acamprosate, according to a press announcement about this study. However, clinical trials suggest disulfiram may not be the best at preventing alcohol abuse, according to that announcement.

“When clinicians decide to use one of the medications, a number of factors may help with choosing which medication to prescribe, including the medication’s efficacy, administration frequency, cost, adverse events, and availability,” the authors concluded.

Fewer than one-third of alcohol abusers get treatment. Of those who do seek treatment, less than 10 percent get prescribed medications, these researchers wrote, citing previous studies.

As the researchers were testing the effects of those medications on alcohol cravings and consumption, they also were investigating the medications' side effects. Those side effects prompted some study participants to drop out of the trials.

Anxiety, diarrhea and vomiting were among the side effects of acamprosate. Dizziness, nausea and vomiting were among the side effects for naltrexone. Dizziness, headache, insomnia, vomiting and nausea were side effects of nalmefene. The risks of topiramate included problems with memory and thinking, changes in the tastebuds that caused food and drink to taste unusual, and tingling sensations in various parts of the body.

This study was published online May 13 in JAMA.

The US Department of Health and Human Service’s Agency for Healthcare Research and Quality funded this study.

These researchers reported that they had no financial investments or ethical conflicts that might affect study design, outcomes or analysis.

Review Date: 
May 13, 2014