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Selecting an appropriate alcohol pharmacotherapy

review of recent findings

Castrén, Saria,b; Mäkelä, Niklasc; Alho, Hannua,d

Current Opinion in Psychiatry: July 2019 - Volume 32 - Issue 4 - p 266–274
doi: 10.1097/YCO.0000000000000512
ADDICTIVE DISORDERS: Edited by John B. Saunders and Linda B. Cottler

Purpose of review Only a few pharmacological treatments are available for treating alcohol use disorders (AUDs). Disulfiram, naltrexone and acamprosate are Food and Drug Administration (FDA)-approved and nalmefene is EMA-approved in European Union. Off-label medications, such as baclofen, gabapentin, ondansetron and topiramate are medications commonly prescribed for the treatment of AUD. The aim of this review is to give an update on recent randomized controlled trials (RCTs) and reviews evaluating pharmacological treatment for AUD.

Recent findings A literature search was conducted for pharmacological treatment for alcohol use disorder, published from January 2017 to January 2019. An additional search from two ongoing-study databases was performed. A total of 13 studies, 11 reviews and 7 on-going clinical trials were identified. Interest in studying baclofen as a treatment for AUD was greater compared with other medications, yet with inconclusive results. Three new RCTs of first-line medication naltrexone showed reduction in drinking.

Summary Three new published RCTs focus on baclofen and naltrexone. These results are consistent with old findings demonstrating that naltrexone reduces heavy drinking. Several RCT on baclofen do not support the use of baclofen for treatment of AUD. Encouraging results have been reported for topiramate, gabapentin and also varenicline, which might be useful in patients with comorbid nicotine dependence.

aNational Institute for Health and Welfare, Alcohol, Drugs and Addictions Unit, Helsinki

bFaculty of Social Sciences, Department of Psychology and Speech-Language Pathology, University of Turku, Turku

cFaculty of Medicine, Department of Internal Medicine

dAbdominal Center, University and University Hospital of Helsinki, University of Helsinki, Finland

Correspondence to Sari Castrén, PhD, Adjunct Professor, Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland. E-mail:

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