Table 1.

Medications for AUD

MEDICATION	ACTION	EFFECTIVENESS	DOSAGE	CONTRAINDICATIONS AND SIDE EFFECTS
Naltrexone	Blocks opioid receptor and reduces euphoric effects of drinking	NNT = 12 to prevent heavy drinking and NNT = 20 for abstinence¹⁹	25 mg for 3 d (to reduce GI effects) then increase to 50 mg/d to a maximum of 100 mg/d Patients do not need to abstain before starting	Contraindications Taking opioids Elevated liver enzymes (> 3 times normal range) Liver failure (caution with dysfunction or disease) Pregnancy Side effects GI upset Elevated liver enzymes Monitoring Measure liver enzymes at baseline, 4 wk, then every 3 mo Discontinue naltrexone if levels rise > 3 times baseline
Acamprosate	Antagonizes glutamate receptors (excitatory neurotransmitter)	NNT = 12 to achieve abstinence¹⁹	666 mg 3 times daily or 333 mg 3 times daily if there is renal impairment or body weight is < 60 kg Patients should abstain for at least 4 d before initiation	Contraindications Serious renal disease Pregnancy Side effects GI upset Nervousness
Disulfiram	Blocks conversion of acetaldehyde to acetic acid and causes a buildup of acetaldehyde. Patients experience sweating, palpitations, and hypotension. Effects can be severe and, in very rare cases, fatal	Has positive outcomes when taken with supervision²⁰ (by partner, pharmacist, or AA sponsor) Compares favourably to naltrexone and acamprosate in head-to-head trials	250 mg/d (range 125 mg to 500 mg) Must be abstinent at least 2 d before initiation Disulfiram reaction can occur up to 10 d after stopping medication	Contraindications Elderly Cardiac disease Liver dysfunction, disease, or failure Psychosis Cognitive dysfunction Pregnancy Side effects Hepatitis Neuropathy Depression Psychosis Monitoring Measure liver enzymes at baseline, 2 wk, and then every 3 mo Discontinue if levels rise > 3 times normal range

MEDICATION

ACTION

EFFECTIVENESS

DOSAGE

CONTRAINDICATIONS AND SIDE EFFECTS

Naltrexone

Blocks opioid receptor and reduces euphoric effects of drinking

NNT = 12 to prevent heavy drinking and NNT = 20 for abstinence¹⁹

25 mg for 3 d (to reduce GI effects) then increase to 50 mg/d to a maximum of 100 mg/d
Patients do not need to abstain before starting

Contraindications

Taking opioids
Elevated liver enzymes (> 3 times normal range)
Liver failure (caution with dysfunction or disease)
Pregnancy

Side effects

GI upset
Elevated liver enzymes

Monitoring

Measure liver enzymes at baseline, 4 wk, then every 3 mo
Discontinue naltrexone if levels rise > 3 times baseline

Acamprosate

Antagonizes glutamate receptors (excitatory neurotransmitter)

NNT = 12 to achieve abstinence¹⁹

666 mg 3 times daily or 333 mg 3 times daily if there is renal impairment or body weight is < 60 kg
Patients should abstain for at least 4 d before initiation

Contraindications

Serious renal disease
Pregnancy

Side effects

GI upset
Nervousness

Disulfiram

Blocks conversion of acetaldehyde to acetic acid and causes a buildup of acetaldehyde. Patients experience sweating, palpitations, and hypotension. Effects can be severe and, in very rare cases, fatal

Has positive outcomes when taken with supervision²⁰ (by partner, pharmacist, or AA sponsor)
Compares favourably to naltrexone and acamprosate in head-to-head trials

250 mg/d (range 125 mg to 500 mg)
Must be abstinent at least 2 d before initiation Disulfiram reaction can occur up to 10 d after stopping medication

Contraindications

Elderly
Cardiac disease
Liver dysfunction, disease, or failure
Psychosis
Cognitive dysfunction
Pregnancy

Side effects

Hepatitis
Neuropathy
Depression
Psychosis

Monitoring

Measure liver enzymes at baseline, 2 wk, and then every 3 mo
Discontinue if levels rise > 3 times normal range

AA—Alcoholics Anonymous, AUD—alcohol use disorder, GI—gastrointestinal, NNT—number needed to treat.