Four medications have clinical value in treating patients with alcohol-
use disorders, according to a review in JAMA.
Researchers examined over 120 studies of medications used for alcohol-
use disorders. Some 23,000 patients were enrolled, most after
detoxification or a period of sobriety.
Acamprosate (a glutamine antagonist and γ-aminobutyric acid agonist)
and oral naltrexone (an opioid antagonist) were about equally
effective in preventing resumption of any drinking.
Naltrexone was also effective in reducing heavy drinking, but
acamprosate was not.
Disulfiram (an acetaldehyde dehydrogenase inhibitor) did not reduce
Two off-label medications — nalmefene (an opioid antagonist) and
topiramate (an anticonvulsant) — were associated with improvements in
heavy drinking. There was insufficient evidence for other off-label
drugs, including SSRIs, tricyclic antidepressants, atypical
antipsychotics, and gabapentin.