Disulfiram is most commonly known by the original brand name, Antabuse®. Some people may confuse the way disulfiram works to help people quit drinking, with the way the newer medications work. The mechanisms of the available agents are different in each case.  Disulfiram has been used effectively for more than 60 years to help people stop drinking. Disulfiram works by inhibiting one of the enzymes involved in the breakdown and elimination of alcohol by-products from the body. Build up of these by-products occurs if you were to drink after taking disulfiram, resulting in very unpleasant feeling that has been likened to a bad hangover. You may experience symptoms like nausea and vomiting, flushing, sweating, and heart palpitations.  Taking disulfiram often involves the help of a close friend or family member to monitor the daily dosing of the medication as the medication will be cleared from the body and therefore not effective within about two to three days from the last dose. Compliance with treatment is important to ensure that the drug remains in their system at all times. Having someone to monitor compliance prevents the person from stopping the doses on their own, then going back to drinking alcohol. Using disulfiram requires a commitment to abstinence.  Be aware of safety issues with disulfiram. Serious problems associated with disulfiram involve the dangerous reaction that can occur if you consume alcohol while taking this drug. Topical products that contain alcohol can also trigger that unwanted reaction. The alcohol warning is extended to other drugs that contain alcohol such as some cough syrups and tonics. Disulfiram should not be used in people that are taking metronidazole, or paraldehyde.  Disulfiram is not to be used in people with severe heart disease, psychotic disorders, certain allergies to ingredients found in pesticides, and in people that are exposed to alcohol based chemicals in their work. Naltrexone comes in an oral dosing form, which is given once a day, and an extended-release injectable form, given once a month. There is no physical reaction or sickness if you drink alcohol while receiving naltrexone.  The people that do the best with naltrexone are those that are trying to achieve abstinence. Not everyone is ready, especially at first, to make that commitment. That’s ok.  Naltrexone works by blocking receptors in your brain that are involved in the rewarding, and positive, feelings that happen when you drink. Because it works in the reward center of the brain, naltrexone can also help to reduce cravings.  Research with the oral dosing form of naltrexone has shown an overall reduction in the risk of relapse during the first 3 months of therapy by about 36%. Plus, about 25% of people taking the injectable form of naltrexone experienced fewer heavy drinking days.  Use naltrexone safely. Naltrexone relies on your liver to metabolize the drug into other forms, and to keep your blood level of the drug in a safe range. If you have any liver problems, or signs of liver problems (such as swelling in your legs, bloated abdomen, or intense nausea) while you are taking naltrexone, contact your doctor immediately.  Avoid opiates while taking naltrexone, as naltrexone works by blocking the same receptors that opiates bind to. A serious complication can occur if naltrexone is used when there are opiates, or opiate derivatives in your system. The reaction can be severe if any opiates linger in your system as you begin naltrexone therapy.  Expect your doctor to perform blood work in order to proceed safely. Taking naltrexone while opiates are in your system can induce a sudden, and sometimes severe, situation of opiate withdrawal. Medical attention is warranted if this should occur. Completely avoid opiates during your therapy with naltrexone. Acamprosate, currently marketed under the brand name of Campral®, works in a different way. Again, there is no physical reaction that happens if you drink while taking acamprosate.  Acamprosate is dosed orally, and given 3 times every day. The drug works in your brain by acting on the receptors that cause the uncomfortable symptoms when you are trying to stop drinking.  Some of the symptoms acamprosate can help to minimize include insomnia, anxiety and jitteriness, restlessness, and feeling generally unhappy with life.  Studies show that acamprosate may be especially helpful in people that have been drinking for a long time. Plus, the people that did the best with this drug were those that wanted to reach a goal of abstinence. As many as 36% of people taking acamprosate were able to maintain their abstinence for at least 6 months.  Know more about taking acamprosate safely. Avoid using this drug if you have severe kidney problems. Acamprosate depends on your kidney function to remove the drug from your system with routine use. You should not take acamprosate if you have serious kidney disease.  Do not take acamprosate if you have certain allergies. People that are allergic to sodium sulfite or sulfite containing products should not take acamprosate. Sulfite sensitivity is more common in people with asthma. Sulfites are found in a variety of foods.  Some examples include prepared food products such as dried fruit, canned fruits or vegetables, some shellfish, and foods made with potatoes, like instant mashed potatoes. Let your doctor know if you have food allergies that may include sulfites.  Watch for feelings of depression or suicidal thoughts. Let your doctor know immediately if you develop feelings of depression or suicide once you start taking acamprosate. These feelings have been reported with this drug, and warrant medical attention if they should develop. Topiramate has shown very promising results in clinical studies; however the drug is not yet approved for use in the treatment of alcohol disorders by the FDA. That means that your doctor can prescribe topiramate for you as an off-label use.  Topiramate is given in oral doses, with the dosing gradually titrated upward to reach the desired results. This drug works by manipulating chemicals involved with the reward center in the brain. This helps to reduce alcohol use, and to reduce associated cravings.  The clinical research studies included people that were still drinking alcohol at the time they were started on the drug. Participants were continuing to show improvement as the 14 week studies came to an end.  Overall, topiramate increased the number of days some people were able to remain alcohol-free, and decreased the number of heavy drinking days for others. While comparative results are not available, the study results suggest that topiramate may be more effective than either naltrexone or acamprosate.  Take topiramate safely. One of the more serious complications caused by the use of topiramate involves your eyes. If left unattended, changes in your vision can lead to potentially permanent damage. Any visual changes should be immediately reported to your doctor.  Be aware of cognitive changes that can occur. Some people report problems with confusion and alertness when taking topiramate. In many cases, these symptoms can be addressed by adjusting the dose.  Pay attention to feeling depressed or having thoughts of suicide. These feelings can possibly develop when taking topiramate. Contact your doctor immediately if you develop these thoughts or feelings.  It is very important that you do not stop taking topiramate altogether. The amount of topiramate in your blood needs to be gradually lowered in order to avoid serious side effects such as seizures. Consult with your doctor before stopping this medication; she can help you taper the dose gradually to prevent unwanted effects.

Summary:
Consider taking disulfiram. Consider taking naltrexone. Ask your doctor about taking acamprosate. Learn how topiramate can help.