Version May 2024
| Initial daily dose | Titration or daily dose range | Select adverse effects* | Contraindications | Dosing and monitoring considerations | |
| First-line agents: For newly diagnosed patients with moderate to severe alcohol use disorder, we prefer naltrexone. In individuals who are prescribed opioids or are using opioids or in those with hepatic failure or acute hepatitis, we use acamprosate. | |||||
| Naltrexone (intramuscular) | 380 mg IM every 4 weeks. | — | Injection site reaction: pain, cellulitis, hematoma, induration, sterile abscess. Neurologic: headache, dizziness, sleep disturbance. Gastrointestinal: nausea, decreased appetite, abdominal pain. Hepatic: increased transaminases. | Hypersensitivity to naltrexone or component of formulation. Current opioid use or prescription for pain management. Hepatic failure or elevated liver enzymes ≥3 to 5 times normal. | May begin treatment while patient is still drinking. Liver enzymes should be monitored within several weeks of initiating treatment and then every 6 months during ongoing treatment. |
| Naltrexone (oral) | 50 mg orally once daily. Some individuals may require titration to 100 mg once daily after 1 week. | Usual dosage range: 50 to 100 mg/day. | Neurologic: headache, dizziness, sleep disturbance. Gastrointestinal: nausea, decreased appetite, abdominal pain. Hepatic: increased transaminases. | ||
| Acamprosate | 666 mg orally 3 times daily. | — | Gastrointestinal: diarrhea. Neurologic: anxiety, insomnia, depression, dizziness. | Hypersensitivity to acamprosate. CrCl <30 mL/min. | Lower initial dose (ie, 333 mg orally 3 times daily) recommended for individuals with moderate kidney impairment (CrCl 30 to 50 mL/min). Lower initial dose (ie, 333 mg 2 times daily) recommended for individuals weighing <60 kg. |
| Second-line agents: In individuals who have not had clinically acceptable response to initial agents, we suggest the following agents. In individuals with seizure disorder, we use topiramate. | |||||
| Disulfiram | Loading dose: 250 to 500 mg orally once daily for 1 to 2 weeks. | After loading dose, average maintenance dose is 250 mg orally once daily (range: 125 to 500 mg/day). | Neurologic: fatigue, headache, bitter (garlic) taste, neuropathy. Hepatic: hepatitis. | Severe myocardial disease, psychosis, hypersensitivity to thiuram derivatives, ongoing alcohol use. | Liver enzymes should be monitored within several weeks of initiating treatment and then every 6 months during ongoing treatment. |
| Topiramate (immediate release) | 25 mg orally once daily. | Increase daily dose by 25 mg per week for 4 weeks, then increase by 50 mg per week to maximum dose of 300 mg per day as tolerated. Daily doses >50 mg are administered in divided doses.¶ | Gastrointestinal: abdominal pain, diarrhea, nausea. Metabolic: weight loss. Neurologic: dizziness, drowsiness, fatigue, cognitive impairment (eg, memory impairment, word finding difficulties), paresthesias. | Hypersensitivity to topiramate. | Lower doses (eg, 50% dose reduction) and slower titration recommended for kidney impairment (CrCl <70 mL/min/1.73 m2). |
| Gabapentin | 300 mg orally once daily. | Increase daily dose by 300 mg every 1 to 2 days as tolerated to target dose of 600 mg 3 times daily. | Neurologic: dizziness, drowsiness, mood changes. Gastrointestinal: nausea, diarrhea. Risk for misuse and addiction. | Hypersensitivity to gabapentin or components of formulation. | Lower doses recommended for kidney impairment (CrCl <50 mL/min). |
IM: intramuscularly; CrCl: creatinine clearance.
* This is not a complete list. For more information, refer to Lexicomp drug information included with UpToDate.
¶ Refer to topiramate dose-escalation table in UpToDate.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
