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Table 6 Select Effects of Medications on Drinking Outcomes

From: Care for hospitalized patients with unhealthy alcohol use: a narrative review

Medication Drinking Outcome Effect estimate Source Factors Influencing Medication Choice
   (95% CI or p-value)   
Naltrexone Heavy drinking day (≥ 60 grams alcohol) Relative risk 0.83 Meta-analysis of 50 Avoid in patients with opioid abuse or use; caution in liver disease and advanced kidney disease
(0.76-0.90) randomized controlled trial (RCT’s) [87]
Acamprosate Any drinking Relative risk 0.86 Meta-analysis of 24 Avoid with advanced kidney disease
(e.g., creatinine clearance < 30 ml/min)
(0.81-0.91) RCT’s [86]
Disulfiram Any drinking Slight majority of trials found improved abstinence. Review of 11 RCT’s [85] Avoid if alcohol-disulfiram reaction medically dangerous; number of medical conditions associated with accidental reaction; avoidance of alcohol-containing products
Topiramate* % heavy drinking days 8.4% reduction Multicenter RCT [83] Caution with advanced liver or kidney disease; risk for metabolic acidosis with predisposing conditions; avoid abrupt discontinuation
Ondansetron* Average number of drinks on days alcohol was consumed If alcoholism onset before age 25, 4.28 relative to 6.9 in placebo(p=0.004) RCT [84] Not shown to be beneficial for later-onset alcohol dependence; may prolong QT interval
  1. *Not FDA-approved for treating alcohol dependence.