Pharmacotherapy for alcohol dependence
Agency for Healthcare Research and Quality (AHRQ)
Record ID 32000008240
This report focuses on the pharmacotherapies used for the treatment of alcohol dependence. The report is organized around a series of major clinical questions on the pharmacotherapy for alcohol dependence. They involve pharmaceutical agents that have been historically or are presently used in the treatment of alcoholism: disulfiram, the opiate antagonists naltrexone and nalmefene, serotonergic agents such as ondansetron, buspirone, and the selective serotonin reuptake inhibitors (SSRIs, such as citalopram, fluoxetine, paroxetine, sertraline, etc.), and lithium.
Authors' recommendations: Disulfiram - A substantial literature has been generated on the use of disulfiram in alcoholism, but the number of controlled clinical trials is limited. - Controlled clinical trials of disulfiram reveal mixed findings. There is little evidence that disulfiram enhances abstinence, but there is evidence that disulfiram reduces drinking days. - When measured, compliance is a strong predictor of outcome. - Studies of disulfiram implants are methodologically weak and generally without good evidence of bioavailability. - Studies of supervised disulfiram administration are provocative but limited. Naltrexone - Trials of naltrexone in the treatment of alcoholism are recent and of generally good quality. - There is good evidence that naltrexone reduces relapse and number of drinking days in alcohol-dependent subjects. - There is some evidence that naltrexone reduces craving and enhances abstinence in alcohol-dependent subjects. - There is good evidence that naltrexone has a favorable harms profile. Acamprosate - Trials of acamprosate in alcohol dependence are large but limited to European populations. - There is good evidence that acamprosate enhances abstinence and reduces drinking days in alcohol-dependent subjects. - There is minimal evidence on the effects of acamprosate on craving or rates of severe relapse in alcohol-dependent subjects. - There is good evidence that acamprosate is reasonably well tolerated and without serious harm. Serotonergic Agents - There are several controlled clinical trials of serotonergic agents in primary alcoholics without comorbid mood or anxiety disorders. - There is minimal evidence on the efficacy of serotonergic agents for treatment of the core symptoms of alcohol dependence. - There is some evidence on the efficacy of serotonergic agents for the treatment of alcohol-dependent symptoms in patients with comorbid mood or anxiety disorders, although the data are limited. Lithium - There are limited studies on the effects of lithium in primary alcoholics without comorbid mood disorders. - There is evidence that lithium is not efficacious in the treatment of the core symptoms of alcohol dependence. - There is minimal evidence for efficacy of lithium for the treatment of alcohol-dependent symptoms in patients with comorbid depression.
Authors' methods: Review
Project Status: Completed
URL for project: http://www.ahrq.gov/clinic/
Year Published: 1999
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
Organisation Name: Agency for Healthcare Research and Quality
Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;
Contact Name: firstname.lastname@example.org
Contact Email: email@example.com
Copyright: Agency for Healthcare Research and Quality (AHRQ)
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