Disulfiram Acamprosate

Currently, three drugs are approved in the U.S. for treatment of alcoholism disulfiram (antabuse), naltrexone (revia), and acamprosate. Disulfiram has a long history of use but has fallen into disfavor because of its side effects and problems with patient adherence to therapy. Naltrexone and acamprosate were introduced more recently. The goal of these medications is to assist the patient in maintaining abstinence. 

Besson J, Aeby F, Kasas A, et al Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism a controlled study. Alcohol Clin Exp Res 22 373-579, 1998... 

Currently the three FDA-approved medications that are indicated to treat alcohol dependence are disulfiram, naltrexone, and acamprosate. Both disulfiram and acamprosate are indicated in patients who have already achieved initial abstinence. Only naltrexone may be initiated without regard to abstinence status. 

The therapeutic dose of acamprosate is 666 mg orally three times daily, and it is supplied as a 333 mg tablet. It can be started at the full dose in most patients without titration. It differs from disulfiram and naltrexone in that it is excreted by the kidneys without liver metabolism. Consequently, it is contraindicated in patients with severe renal impairment (creatinine clearance less than or equal to 30 mL/minute), and dose reduction is necessary when the creatinine clearance is between 30 and 50 mL/minute. The most common side effects are gastrointestinal and include nausea and diarrhea. Rates of suicidal thoughts were also increased in patients treated for 1 year with acamprosate (2.4%) versus placebo (0.8%). If necessary the total daily dose maybe decreased by 1 to 3 tablets (333-999 mg) per day to alleviate side effects. 

Disulfiram (250 mg per day) can be used to promote abstinence from alcohol. Acamprosate and naltrexone can be used to decrease craving for alcohol, but they are not likely to result in complete abstinence from alcohol use. 

Acamprosate is not known to cause alcohol aversion and does not cause a disulfiram-like reaction as a result of ethanol ingestion. 

Three drugs—disulfiram, naltrexone, and acamprosate—have FDA approval for adjunctive treatment of alcohol dependence. 

Currently, disulfiram, naltrexone, and acamprosate are currently the only treatments approved for the management of alcohol dependence. Studies in animals have demonstrated that a diet enriched in vitamin E and saturated fatty acids reduces alcoholic liver injury by decreasing hpid per-oxidation. " Liver transplantation is the treatment of choice in end-stage liver disease. The results of transplantation in alcoholic liver disease are comparable to those with other forms of hver disease. ... 

DRD2 Dopamine receptor D2 rs6277, rsl799978, rs6275 Cocaine, alcohol, opioids Acamprosate, bromocriptine, disulfiram, methadone... 

Anton RF Pharmacologic approaches to the managemeht ot alcoholism. J Clin Psychiatry 2001 2 SuppI 20 11-17. [PMID 11584870] (Review Of ahimal and clinical studies of disulfiram, acamprosate, and naltrexone.)... 

Of course, these symptoms can also be cured by ethanol itself and relapse is common in the first few months after withdrawal. To help avoid relapse, acamprosate, a weak NMDA antagonist, is sometimes used. This drug appears to help diminish fedings of craving. Naltrexone, an opioid receptor antagonist, can block reward pathways that are activated by alcohol and so break the fink between alcohol and its reinfordng effects. An alternative approach of aversion therapy is provided by the dmg disulfiram. 

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