Medications for Alcoholism and Alcohol Abuse

Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

On June 30, 2005, the FDA issued a similar advisory regarding antidepressant use by adults, warning about a possible increase in suicidal thinking or behavior early in treatment or when dosage of the medication is changed. The advisory covers all the drugs in the above paragraph plus Cymbalta (duloxetine).

For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Alcohol Abuse Adjunct Therapy

• Naltrexone (ReVia)

Naltrexone (ReVia) is used to help you to stay away from alcohol, but it is not a cure for addiction. It may work by blocking the high that makes you crave alcohol. It will not, however, prevent you from experiencing the effects of alcohol.

Possible side effects include:

• Stomach cramps
• Headache
• Muscle or joint pain
• Anxiety, nervousness, and insomnia
• Fatigue
• Nausea and vomiting

Alcohol Abuse Deterrent

• Disulfiram (Antabuse)

Disulfiram (Antabuse) helps you overcome your drinking problem by making you very sick if you drink alcohol. However, it does not "cure" alcoholism. While you take this medicine, and for 14 days before you begin taking it, you should not drink even the smallest amount of alcohol. You should not use any foods, products, or medicines that contain alcohol, nor should you come into contact with any chemicals that contain alcohol while using this medicine.

If you use alcohol while taking this medicine, you may experience some of the following symptoms:

• Nausea and vomiting
• Chest pain
• Dizziness or fainting
• Sweating and flushing
• Difficulty breathing
• Confusion
• Weakness
• Rapid heart beat
• Drowsiness

Symptoms will last from 30 minutes to several hours.

Acamprosate

• Campral

Acamprosate (Campral) reduces your craving for alcohol by inhibiting a chemical in your brain called gamma aminobutyric acid (GABA). Several studies have indicated that it may help you remain abstinent.

Possible side effects include:

• Diarrhea
• Headache

Selective Serotonin Reuptake Inhibitors (SSRIs)

*** see note above

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Fluvoxamine (Luvox)

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety and depression. SSRIs may be used to reduce cravings for alcohol. They are also helpful if you have a coexisting psychiatric problem, such as an anxiety disorder or depression. Improvement is usually seen in four to six weeks after beginning treatment.

Possible side effects include:

• Nausea
• Diarrhea
• Insomnia
• Sexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)

Azapirones

• Buspirone (BuSpar)

Buspirone is a relatively new anti-anxiety drug. It may be used in the treatment of alcoholism and withdrawal symptoms, as well as a coexisting anxiety disorder. It takes from two to four weeks for improvement to be evident. For this reason, this drug is not useful for treating acute anxiety and insomnia. The primary advantages of buspirone are that it is less sedating than benzodiazepines and it does not result in physical dependence or tolerance.

Buspirone should be taken with food to increase absorption. Do not take with MAO inhibitors. Avoid alcohol in excessive amounts when taking this medication due to possible adverse reactions.

Possible side effects include:

• Excitability
• Headache
• Nausea
• Dizziness

Benzodiazepines

• Diazepam (Valium)
• Chlordiazepoxide (Librium)
• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Midazolam (Versed)
• Oxazepam (Serax)

Benzodiazepines are anti-anxiety drugs that may be used to relieve withdrawal symptoms of alcoholism and reduce the risk of seizures. These drugs produce a sedative effect and are fast-acting. Benzodiazepines are usually not used for long periods of time because they can lead to dependence and may cause withdrawal symptoms when discontinued.

Possible side effects include:

• Drowsiness
• Dizziness

Newer Treatments

• Topiramate (Topamax)

Recently, a study showed that an anticonvulsant drug, topiramate (Topamax), may reduce alcohol dependence. Over the course of 14 weeks, 371 patients (aged 18-65) diagnosed with alcohol dependence were randomly selected to receive topiramate (up to 300 mg per day) or placebo. More subjects in the topiramate group experienced ≥ 28 days of continuous abstinence and continuous non-heavy drinking, respectively, compared to the control group. (Heavy drinking was defined as five or more drinks a day for men, and four or more drinks a day for women.) Fifty-one percent of those taking topiramate, though, experienced a sensation of tingling or numbness of the skin (called paresthesias), which was attributed to the high dose of medication.*

Possible side effects include:

• Numbness and tingling
• Headache
• Taste alteration
• Fatigue
• Loss of appetite
• Dizziness

Special Considerations

Contact your healthcare provider if your medication does not seem to be working after the allotted period of time or if you have any side effects that are troublesome or persistent.