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Acamprosate and Oral Naltrexone Are Effective—but Underutilized—Medications for Alcohol Use Disorder

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Alcohol use disorder (AUD) is one of the most prevalent substance use disorders in the US. Effective medications for AUD (MAUD) have been available for over 40 years; however, less than 1 percent of individuals with AUD receive them. A recent systematic review of studies lasting ≥12 weeks described the effects on alcohol consumption of FDA-approved MAUD (i.e., acamprosate, disulfiram, and naltrexone), and those that are prescribed off-label for AUD (i.e., baclofen, gabapentin, varenicline, topiramate, prazosin, and ondansetron).

  • Of the 118 clinical trials that were included, 100 combined MAUD and non-medication treatments (e.g., counseling).
  • There was moderate strength of evidence for the use of acamprosate and oral naltrexone (50mg/day) for reducing return to any drinking and percentage of drinking days (numbers needed to treat [NNT] to prevent one person from returning to any drinking = 11 for acamprosate and 18 for oral naltrexone).
  • Oral naltrexone (50mg/day) had moderate strength of evidence for reduction of return to heavy drinking (NNT = 11, compared with placebo).
  • Studies involving disulfiram were limited. Studies of baclofen and gabapentin had low strength of evidence. Topiramate had moderate strength of evidence for reduction in drinking days, but had more adverse effects.
  • Health outcomes like motor vehicle crashes, injuries, quality of life, function, and mortality were infrequently reported.
  • Overall adverse effects were low across studies.

Comments: In this systematic review and meta-analysis, the evidence was strongest for the benefit of naltrexone and acamprosate, which appear to have approximately equal efficacy for treating AUD. The well-established benefits of MAUD suggest that, in the absence of clinical contraindications, all patients who have AUD should be offered one of these two medications. Given the prevalence of AUD in the US and worldwide, inclusive studies exploring all treatment options in all populations—including minoritized and older populations, and individuals with comorbidities such as liver disease—are greatly needed.

(Source: Boston Medical Centre)