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*

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