Pharmacotherapy of alcoholism – an update on approved and off-label medications

  title={Pharmacotherapy of alcoholism – an update on approved and off-label medications},
  author={Michael Soyka and Christian A. M{\"u}ller},
  journal={Expert Opinion on Pharmacotherapy},
  pages={1187 - 1199}
ABSTRACT Introduction: Only a few medications are available for the treatment of alcohol use disorders (AUDs). Areas covered: This paper discusses approved AUD medications, including the opioid antagonists naltrexone and nalmefene (the latter is licensed for reduction of alcohol consumption only), the putative glutamate receptor antagonist acamprosate and the aldehyde dehydrogenase inhibitor disulfiram. It also covers off-label medications of interest, including topiramate, gabapentin… 
Pharmacogenetics of alcohol use disorder treatments: an update
This work reviews the literature on the pharmacogenetics of AUD treatment using both approved and off-label medications, highlighting valuable mechanistic insights and underscoring the potential value of precision-based care for AUD.
Baclofen in the Treatment of Patients With Alcohol Use Disorder and Other Mental Health Disorders
A narrative review of the scientific literature related to the use of baclofen in AUD, both in patients with and without concomitant psychiatric disorders indicates that the most frequent psychiatric comorbidities in patients affected by AUD undergoing bacl ofen treatment are anxiety and mood disorders.
Gabapentin for Post-Hospitalization Alcohol Relapse Prevention; Should Gabapentin Be Considered for FDA Approval in the Treatment of Alcohol Use Disorder?: A Case Presentation and Literature Review
A case presentation and literature review demonstrating the role of gabapentin in treating AUD and symptoms associated with alcohol withdrawal, along with its potential use in relapse prevention are discussed.
Preclinical evaluation of avermectins as novel therapeutic agents for alcohol use disorders
Findings support the utility of avermectins as a novel class of drug candidates for treatment of AUDs by supporting the involvement of P2X4Rs in IVM’s anti-alcohol effects and that P2x4Rs can be used as a platform for developing novel anti- alcohol compounds.
Role of Cannabidiol in the Therapeutic Intervention for Substance Use Disorders
Preclinical and clinical reports regarding the effects of CBD on the regulation of the reinforcing, motivational and withdrawal-related effects of different drugs of abuse such as alcohol, opioids (morphine, heroin), cannabinoids, nicotine, and psychostimulants are reviewed.
New steps for treating alcohol use disorder
New medications, the emergence of digital technology, and other novel approaches such as transcranial magnetic stimulation are discussed with reference to treatments already in practice, and how individual differences in genotype and phenotype may affect outcomes are considered.
Gabapentin for alcohol use disorder: A good option, or cause for concern?
The anticonvulsant drug gabapentin is used off-label to treat alcohol-related withdrawal, cravings, anxiety, and insomnia, and there is concern about the potential for abuse.


Nalmefene for the treatment of alcohol use disorders: recent data and clinical potential
  • M. Soyka
  • Medicine
    Expert opinion on pharmacotherapy
  • 2016
Nalmefene is the first medication to be approved specifically in this indication and seems to be most suitable for patients with alcohol misuse or a rather low physical dependence on alcohol who do not require immediate detoxification or inpatient treatment.
Potential medications for the treatment of alcohol use disorder: An evaluation of clinical efficacy and safety.
A number of alternative medications are now being evaluated for treatment of AUD in human studies, and some show good efficacy with side effects that are mild to moderate in intensity; others have mixed or promising results but are awaiting findings from ongoing studies; and still others show poor efficacy, despite promising preliminary results.
The Status of Disulfiram: A Half of a Century Later
Preliminary evidence suggests that disulfiram treatment could be a viable treatment for cocaine dependence because it was shown to reduce cocaine use among nonalcoholic, cocaine-dependent patients.
Neuropharmacological treatments for alcoholism: scientific basis and clinical findings
Of the medications reviewed, acamprosate’s potential appears to be the most widely established and ondansetron, a serotonin3 antagonist, offers new hope for the treatment of early onset alcoholics; a type of alcoholism most difficult to manage with psychosocial measures alone.
Substitution therapy for alcoholism: time for a reappraisal?
The time now seems right for reappraising the use of substitute prescribing for alcohol dependence, where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality.
Quetiapine for the treatment of alcoholism: scientific rationale and review of the literature.
The effects of quetiapine on drinking outcomes may be due to its effects on mood, anxiety and sleep, which may help alleviate protracted withdrawal symptoms and address psychiatric comorbidities often associated with alcohol use disorders.
Safety and Tolerability of Pharmacological Treatment of Alcohol Dependence: Comprehensive Review of Evidence
Five drugs, including an extended-release injectable suspension of naltrexone, have different safety profiles that need to be balanced with the treatment objective (initiation or continuation of abstinence, or reduction of drinking), individual patient preferences and comorbid conditions.
Aripiprazole for relapse prevention and craving in alcohol use disorder: current evidence and future perspectives
It is submitted that aripiprazole would promote alcohol abstinence and reduce the alcohol seeking behaviour possibly via dopaminergic and serotoninergic modulations at the fronto-subcortical circuits underpinning alcohol reward and craving, impulsive behaviour as well as reduce alcohol-related anxiety/low mood and anhedonia.
Aripiprazole, alcohol and substance abuse: a review.
Given the low number of studies, the frequent absence of placebo or active comparators, and the low statistical power of the studies, a clear conclusion about the use of aripiprazole in alcohol/substance dependence cannot be drawn and the need for further studies is suggested.
The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial
Caramazepine was superior to lorazepam in preventing rebound withdrawal symptoms and reducing post-treatment drinking, especially for those with a history of multiple treated withdrawals, and carbamazepines were equally effective at decreasing the symptoms of alcohol withdrawal.