Which Medications Work the Best to Help Me Stop Drinking?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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While interventions like group or individual therapy are effective for alcohol abuse, 70 percent of people relapse after psychosocial treatment alone. There are several medications that can be used to treat alcohol use disorder, leading to reduced heavy drinking and increased days of abstinence. So here are the fab five to get to know:

1. Naltrexone (Vivitrol)

Naltrexone is one of the first line treatments, and you may start it while you are still drinking without the need for a detox program first.

How does it work? Naltrexone works to suppress alcohol cravings by blocking the mu-opioid receptor. Blocking the effects of naturally occurring opioids will help block the reinforcing effects of alcohol.

How is it taken? In two ways: a tablet daily, or a once-monthly injection. Vivitrol (the brand name of the injection) and naltrexone pills have never been compared in head to head studies so we don’t know which one works better, or if they are the same. Naltrexone cannot be used by people taking opioid medications.

Does naltrexone work? Sort of. Studies show that naltrexone reduced the risk of heavy drinking to 83 percent of the risk in the placebo group (those taking no medications), and decreased drinking days by about 4 percent. It does cause some nausea and headache—though the longer you take it, the fewer symptoms you will have. It is a first line treatment (meaning it is tried before other medications), though as you will see below, it works the same compared to topiramate.

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2. Disulfiram (Antabuse)

Disulfiram cannot be started while you are still drinking. In fact, it will make you quite sick if you take it with alcohol, which is sort of the point of it.

How does it work? Disulfiram inhibits aldehyde dehydrogenase so it prevents the metabolism of alcohol’s primary metabolite, acetaldehyde. Nausea, vomiting headache and flushing will occur if you drink alcohol while taking this medication.

How is it taken? Disulfiram is a pill taken at a dose of 500 mg per day for one to two weeks, then lowered to 125 mg a day.

Does it work? Not so well. A 2014 meta-analysis did not find that it was any better than placebo. It may work in a small subset of people who are given it under supervised conditions.

3. Acamprosate (Campral)

Acamprosate should also be used once you’ve stopped drinking.

How does it work? Acamprosate works to dampen desire for alcohol by modulation of glutamate receptors in the brain.

How is it taken? Acamprosate is a pill, and you’ll take two pills, three times a day.

Does it work? Acamprosate has had mixed results and does not appear to have a significant effect on heavy drinking. Some studies show it does work in others. In those cases, it reduces the rate of return to any drinking, and increases abstinence rates by 11 percent. It is generally well tolerated, though diarrhea is the most common side effect reported.

4. Topiramate (Topamax)

Topiramate is used for migraine prevention, seizure disorder, and to suppress appetite—and now for alcohol dependence. It can be used if you are still drinking.

How does it work? Topiramate works by altering the balance of chemicals in the brain, which reduces the “rewarding” effect of consuming alcohol.

How is it taken? You’ll increase your dose of topiramate gradually over several weeks, starting at 25 mg per day and increasing to a maximum of 75 mg a day.

Does it work? Yes, a review of several studies found that topiramate reduced the percentage of heavy drinking days compared to placebo when taken over 14 weeks. Three trials comparing naltrexone to topiramate found no difference in outcome, so both appear to work the same.

5. Baclofen (Lioresal)

Baclofen is a muscle relaxant that has been found in small studies to be effective in the treatment of alcohol dependence.

How does it work? Baclofen also reduces the “reward” you feel from consuming alcohol.

How is it taken? Baclofen is available as 10 mg tablets, and in studies, the effective dose was 10 mg three times daily (30 mg).

Does it work? People taking baclofen for 12 weeks were more likely to be abstinent from alcohol (71% vs 29%). Taken at a day it may be effective for alcohol dependence. Baclofen is well tolerated and has been around forever, so it is a tempting option.

How long will you take any of these medications?

Most research suggests two to six months, with at least six months being the preference of most experts.

Can I just stop the meds or do I need to taper?

Only topiramate (Topamax) requires a tapering to discontinue it over a few weeks.

Dr O.

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