Common Adverse Nausea Injection-site reaction, Diarrhea Somnolence Effects (≥ 10%) tenderness, induration Metallic taste Nausea Headache Headache Asthenic conditions Anxiety Insomnia Abdominal pain Diarrhea Vomiting Pharyngitis Anorexia Other Adverse Effects Headache Depression Anxiety Dizziness Somnolence Asthenia Nervousness Dry mouth Depression Fatigue Insomnia Insomnia Vomiting Anxiety Somnolence Drug Interactions Opioid-containing Opioid-containing Naltrexone: 33% Alcohol containing medications, medications, including increase in Cmax of medications, including including OTC OTC preparations acamprosate (no OTC preparations preparations dosage adjustment Thioridazine (increased Drug-drug interactions is recommended) Thioridazine lethargy and may occur with (increased lethargy somnolence) Antidepressants: phenytoin, warfarin, and somnolence) weight gain and isoniazid, rifampin, weight loss more diazepam, common than with chlordiazepoxide, either medication imipramine, alone desipramine, and oral hypoglycemic agents Monitoring Ongoing alcohol use, craving, medication adherence, adverse effects, emerging symptoms (e.g., depression, suicidality), biomarkers of unhealthy alcohol use (e.g., blood pressure, gamma glutamyl transferase (GGT), mean corpuscular volume (MCV), HbA1c, carbohydrate-deficient transferrin (CDT)) Repeat liver Repeat liver Serum creatinine / Repeat liver transaminases at 6 transaminases at 6 and CrCl, at baseline transaminases in 10 to and 12 months and 12 months and then and as clinically 14 days, monthly for 3 then every 12 every 12 months indicated thereafter, months, and every 12 months thereafter thereafter particularly in months thereafter patients with renal Efficacy and safety CBC, serum chemistries, impairment and the beyond 8 months is liver transaminases / elderly unclear; after 8 LFTs months, reassess Efficacy and safety patient regularly for beyond 1 year of adverse effects and treatment is need for uncertain; after 1 continuation of year, reassess therapy patient regularly for adverse effects and need for continuation of therapy
Common Adverse Effects (≥ 10%) Nausea Injection-site reaction, tenderness, induration Nausea Headache Asthenic conditions Anxiety Insomnia Abdominal pain Diarrhea Vomiting Pharyngitis Anorexia Diarrhea Somnolence Metallic taste Headache Other Adverse Effects Headache Dizziness Nervousness Fatigue Insomnia Vomiting Anxiety Somnolence Depression Somnolence Dry mouth Anxiety Asthenia Depression Insomnia Drug Interactions Opioid-containing medications, including OTC preparations Thioridazine (increased lethargy and somnolence) Opioid-containing medications, including OTC preparations Thioridazine (increased lethargy and somnolence) Naltrexone: 33% increase in Cmax of acamprosate (no dosage adjustment is recommended) Antidepressants: weight gain and weight loss more common than with either medication alone Alcohol containing medications, including OTC preparations Drug-drug interactions may occur with phenytoin, warfarin, isoniazid, rifampin, diazepam, chlordiazepoxide, imipramine, desipramine, and oral hypoglycemic agents Monitoring Ongoing alcohol use, craving, medication adherence, adverse effects, emerging symptoms (e.g., depression, suicidality), biomarkers of unhealthy alcohol use (e.g., blood pressure, gamma glutamyl transferase (GGT), mean corpuscular volume (MCV), HbA1c, carbohydrate-deficient transferrin (CDT)) Repeat liver transaminases at 6 and 12 months and then every 12 months thereafter Efficacy and safety beyond 8 months is unclear; after 8 months, reassess patient regularly for adverse effects and need for continuation of therapy Repeat liver transaminases at 6 and 12 months and then every 12 months thereafter Serum creatinine / CrCl, at baseline and as clinically indicated thereafter, particularly in patients with renal impairment and the elderly Efficacy and safety beyond 1 year of treatment is uncertain; after 1 year, reassess patient regularly for adverse effects and need for continuation of therapy Repeat liver transaminases in 10 to 14 days, monthly for 3 months, and every 12 months thereafter CBC, serum chemistries, liver transaminases / LFTs
Alcohol_Use_Disorder_Pharmacotherapy_Acamprosate_Naltrexone_Disulfiram_Recommendations_for_Use.docx