Recommended Alcohol abstinence at Alcohol abstinence at Alcohol abstinence at Abstinence is the Conditions for Use in treatment initiation treatment initiation treatment initiation treatment goal Alcohol Dependence Patients willing to receive Most clinical trials Abstinence > 24 and monthly injections have evaluated / or blood or breath acamprosate alcohol level is zero Patients with difficulty therapy adhering to an oral Failure of or concomitantly with regimen contraindication to some type of naltrexone psychosocial Previous response to therapy disulfiram to Capacity to appreciate risks and benefits and to consent to treatment Note: Most effective with monitored administration (e.g., in clinic or with spouse or probation officer.) Use in patients with concomitant cocaine dependence can be considered case by case. Considerations for Pretreatment Pretreatment abstinence May support Limited data available on Use abstinence from from alcohol is not abstinence in comparative efficacy alcohol is not required but improves patients, who are and safety required but response already abstinent improves response (small to moderate Greater benefit may be effect size) seen in patients who May be efficacious for achieve some duration reducing heavy of alcohol abstinence drinking (small (e.g. 2–4 days) prior to effect size) the initial injection of Most trials for oral naltrexone. NTX required as an inclusion criterion pretreatment abstinence of 4 or ≥ 7 days. This is the ≥ subgroup of patients in which oral NTX was shown to be efficacious.
Recommended Conditions for Use in Alcohol Dependence Alcohol abstinence at treatment initiation Alcohol abstinence at treatment initiation Patients willing to receive monthly injections Patients with difficulty adhering to an oral regimen to Alcohol abstinence at treatment initiation Most clinical trials have evaluated acamprosate therapy concomitantly with some type of psychosocial therapy Abstinence is the treatment goal Abstinence > 24 and / or blood or breath alcohol level is zero Failure of or contraindication to naltrexone Previous response to disulfiram Capacity to appreciate risks and benefits and to consent to treatment Note: Most effective with monitored administration (e.g., in clinic or with spouse or probation officer.) Use in patients with concomitant cocaine dependence can be considered case by case. Considerations for Use Pretreatment abstinence from alcohol is not required but improves response May be efficacious for reducing heavy drinking (small effect size) Most trials for oral NTX required as an inclusion criterion pretreatment abstinence of ≥ 4 or ≥ 7 days. This is the subgroup of patients in which oral NTX was shown to be efficacious. Pretreatment abstinence from alcohol is not required but improves response Greater benefit may be seen in patients who achieve some duration of alcohol abstinence (e.g. 2–4 days) prior to the initial injection of naltrexone. May support abstinence in patients, who are already abstinent (small to moderate effect size) Limited data available on comparative efficacy and safety
Alcohol_Use_Disorder_Pharmacotherapy_Acamprosate_Naltrexone_Disulfiram_Recommendations_for_Use.docx