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Medication Dose Target Population Major Side Effects Mechanism

Naltrexone

(Vivitrol, ReVia)

Oral: 50 mg PO daily (increase to 100 as tolerated)

 

IM: 380 mg IM

Q 28 days

People wanting to abstain from both ETOH and Opioids (not currently using)

 

People who want to try to abstain completely from ETOH

Common: GI upset (oral)

 

Rarely depression

 

Very rarely LFT elevation

Opiate receptor blocker

 

Consider ID card or bracelet for safety (especially with Vivitrol, can get from rep)

 

Not clear why works for ETOH

Acamprosate

(Campral)
666 mg PO TID

People who just want to cut down on drinking.

 

People on opioids, Buprenorphine (Suboxone) or methadone

Minimal

Mediates GABA receptors

in the brain (like ETOH)

Disulfiram

(Antabuse)
250 mg PO daily

Best in motivated patient with good support system to ensure adherence

 

Avoid in frail older patients (risk of increased BP, Pulse)

 

Avoid if known esophageal varices (may cause retching if pt drinks while taking)

Increased BP, Pulse

 

Can feel as if you are in severe withdrawal

 

Vomiting if consuming ETOH concurrently

Blocks the ETOH metabolism pathway

 

Leaves high levels of toxic metabolite in the system

 

Mia Sorcinelli, MD Director of Office Based Addiction Treatment at Greater Lawrence Family Health Center

Created: Monday August 6, 2018
Modified: Monday August 6, 2018

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