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Evidence Summary

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In people with alcohol-use disorders, acamprosate (Campral®) and naltrexone (ReVia®) reduce alcohol use

 

Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 May. Report No.: 14-EHC029-EF.

Review questions

In people with alcohol-use disorders, do any medications reduce alcohol use? Do the effective medications have side-effects?

Background

Alcohol-use disorders can range from drinking more than the recommended amounts to alcohol dependence. Alcohol-use disorders increase risk of death, disease (e.g., heart disease, stroke, cancer, high blood pressure, cognitive impairment, decreased bone density), and accidents.

There are many treatments for alcohol-use disorders, including cognitive-behavioural therapy, 12-step programs (e.g., Alcoholics Anonymous), and medications. However, there is no evidence that one treatment approach works better than the others.

How the review was done

The researchers did a systematic review based on studies available up to October 2013.

They found 135 studies, including 124 randomized controlled trials, 5 observational studies, and 6 systematic reviews.

Key features of the studies were:

  • people had alcohol-use disorders;
  • medications included acamprosate (Campral®), aripiprazole (Abilify®), atomoxetine (Strattera®), baclofen (Kemstro®, Lioresal®), buspirone (BuSpar®), citalopram (Celexa®), desipramine (Norpramin®), disulfiram (Antabuse®), fluoxetine (Prozac®, Prozac® Weekly, Rapiflux®, Sarafem®, Selfemra®), fluvoxamine (Luvox®), imipramine (Tofranil®), nalmefene (Selincro®), naltrexone (ReVia®), olanzapine (Zyprexa®), ondansetron(Zofran®, Zuplenz®), paroxetine (Brisdelle®, Paxil®,  Pexeva®), quetiapine (Seroquel®), sertraline (Zoloft®), topiramate (Topamax®), valproate (Depakene®, Depakote®, Stavzor®), and varenicline (Chantix®);
  • people were treated for 12 weeks or more and were not hospitalized;
  • most people received psychosocial treatments in addition to medications
  • treatments were compared with other medications or placebo; and

What the researchers found

The quality of evidence varied. Findings for drinking outcomes that are based on moderate-strength evidence are reported here, with accompanying with side-effects.

Compared with placebo, acamprosate (Campral®):

  • reduced the risk of returning to any drinking by 9%, although the difference could be as little as 4% or as much as 14%;
  • was no better for reducing return to heavy drinking;
  • reduced the number of days of drinking by 9%, although the difference could be as little as 5% or as much as 13%; and
  • increased risk of anxiety, diarrhea, and vomiting.

Compared with placebo, naltrexone (ReVia®), 50 mg orally:

  • was no better for reducing returning to any drinking;
  • reduced the risk of returning to heavy drinking by 9%, although the difference could be as little as 4% or as much as 13%;
  • reduced the number of days of drinking by 5%, although the difference could be as little 3% or as much as 8%;
  • reduced the number of days of heavy drinking by 4%, although the difference could be as little as 1% or as much as 8%; and
  • increased risk of withdrawing from treatment due to side-effects, dizziness, nausea, and vomiting.

Compared with naltrexone (ReVia®), 50 mg orally, acamprosate (Campral®):

  • was no better for reducing return to any drinking;
  • was no better for reducing return to heavy drinking; and
  • slightly increased risk of headache, nausea, and vomiting.

Conclusion

In people with alcohol-use disorders, acamprosate (Campral®) and naltrexone (ReVia®) reduce alcohol use and have minor side-effects.


Effects of medications for alcohol-use disorders on alcohol consumption*

Medication and comparison

Outcomes

Number of studies (people)

Effects of medication

Acamprosate (Campral®) vs placebo

Return to any drinking

16 (4,847)

9% less likely to return to any drinking (as little as 4% and as much as 14% difference)

 

Return to heavy drinking

7 (2,496)

No difference

 

Drinking days

13 (4,485)

9% fewer days of drinking (as little as 5% fewer and as many as 13% fewer)

Naltrexone (ReVia®) (50 mg orally) vs placebo

Return to heavy drinking

19 (2,875)

9% less likely to return to heavy drinking (as little as 4% and as much as 13% difference)

 

Drinking days

15 (1,992)

5% fewer days of drinking (as little as 3% fewer and as many as 8% fewer)

 

Heavy drinking days

6 (521)

4% fewer days of heavy drinking (as little as 1% fewer and as many as 8% fewer)

Acamprosate (Campral®) vs naltrexone (ReVia®)

Return to any drinking

3 (800)

No difference

 

Return to heavy drinking

4 (1,141)

No difference

*Includes evidence of moderate strength (evidence of low or insufficient strength is excluded).



Related Topics


Glossary

Cognitive impairment
Trouble remembering, learning new things, concentrating, or making decisions that affect everyday life.
Observational studies
Studies where the treatment that each person receives is beyond the control of the researcher.
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Alcohol consumption: The benefit is in the dose

    Evidence-based Living
    Moderate alcohol use may have some health benefits (up to one drink per day for women and up to two drinks per day for men). Alcohol use in older people may increase your risk of accidents including falls and fractures.
  • Alcohol use disorder

    Mayo Clinic
    Unhealthy alcohol use can lead to serious problems. It is important to get early treatment. Details in this resource about how to recognize, treat and help others cope with unhealthy alcohol use.
  • Alcohol: Weighing risks and potential benefits

    Mayo Clinic
    You should not start drinking alcohol or drink it more often for potential health benefits. Potential benefits include lower risk of heart disease, stroke, or diabetes. Risks include many serious health problems. The benefits of alcohol consumption do not outweigh the risks.
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