AUD Medication and alcohol use

1. Naltrexone (ReVia, Vivitrol)
  • Mechanism of Action: Opioid receptor antagonist that reduces the pleasurable effects of alcohol, decreasing cravings.
  • Clinical Benefits: Helps reduce heavy drinking and maintain abstinence.
  • Formulations:
    • Oral (ReVia): Taken daily.
    • Extended-release injection (Vivitrol): Administered monthly.
  • Side Effects: Nausea, headache, fatigue, injection site reactions (with Vivitrol).



2. Acamprosate (Campral)
  • Mechanism of Action: Modulates glutamate and GABA neurotransmission to stabilize brain chemistry disrupted by alcohol.
  • Clinical Benefits: Supports abstinence by reducing post-acute withdrawal symptoms like anxiety and insomnia.
  • Dosage: Typically 666 mg taken three times daily.
  • Side Effects: Diarrhea, nausea, and abdominal discomfort.






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3. Disulfiram (Antabuse)
  • Mechanism of Action: Inhibits aldehyde dehydrogenase, causing an aversive reaction (e.g., flushing, nausea, vomiting) if alcohol is consumed.
  • Clinical Benefits: Deters alcohol use by associating drinking with unpleasant effects.
  • Dosage: 250–500 mg daily.
  • Side Effects: Drowsiness, metallic taste, and rarely, hepatotoxicity.







4. Topiramate (Off-Label Use) - Topomax
  • Mechanism of Action: Modulates GABA and glutamate activity, reducing alcohol cravings and reinforcing abstinence.
  • Clinical Benefits: Shown to decrease heavy drinking episodes.
  • Side Effects: Cognitive slowing, dizziness, and weight loss.






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5. Gabapentin (Off-Label Use)
  • Mechanism of Action: Modulates calcium channels to reduce alcohol cravings and withdrawal symptoms.
  • Clinical Benefits: Helps with insomnia, anxiety, and reducing heavy drinking.
  • Side Effects: Sedation, dizziness, and fatigue.
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