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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

(3.1-13.8)

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.