Table 6 -.
Medications for Alcohol Use Disorder (MAUD)
| Drug Name | Mechanism | Liver Safety116 | Efficacy | Common Side Effects |
|---|---|---|---|---|
| Disulfiram 250-500mg QD (FDA approved for AUD) |
Irreversible inhibitor of Aldehyde Dehydrogenase Causes a disulfiram-ethanol reaction which is aversive with alcohol use. Best practice is to include family in dose monitoring |
Hepatic metabolism, cannot start if baseline LFTs are >2x UNL or Tbili > 3mg/dl LiverTox Grade: A (known cause of apparent liver injury) |
Meta-analysis (Skinner, 2014)117 22 RCTs (N=2414) Effect Size = 0.82 (to prevent return to drinking) Requires cessation of alcohol to start |
Drowsiness Tiredness Headache |
| Naltrexone 50mg QD 380mg SC QM (FDA approved for AUD) |
Mu and Kappa-opioid receptor antagonist Reduces cravings and enhances sedative effects of alcohol. Best practice to start SC depot if nonadherence |
Hepatic metabolism, Obtain LFTs at baseline and every 6 months LiverTox Grade: E (unproven but suspected cause of liver injury) |
Meta-analysis (Jonas, 2014)92 53 RCTs (N=9140) NNT=12 (to prevent heavy drinking) Can be started while patient drinking heavily |
Nausea/vomiting Fatigue Dizziness |
| Acamprosate 333-666 mg TID (FDA approved for AUD) |
GABA agonist and partial NMDAR antagonist Tempers cravings and improves insomnia after alcohol cessation. |
No hepatic metabolism but needs renal adjustment. LiverTox Grade: E (unproven but suspected cause of liver injury) |
Meta-analysis (Jonas, 2014)92 27 RCTs (N=7519) NNT = 12 (to prevent return to drinking) Best practice to start one week after cessation |
Diarrhea Nausea/vomiting |
| Baclofen 10-20 mg TID (off label) |
GABA B receptor agonist Inhibits alcohol-induced dopamine release to temper cravings. Also treats muscle tension |
Minimal hepatic metabolism but needs renal adjustment. LiverTox Grade: D (Possible, rare, cause of apparent liver injury) |
Meta-analysis (Pierce, 2018)118 8 RCTs (N=1244) OR = 1.93 (to prevent return to drinking) |
Sedation Dizziness |
| Gabapentin 200-600 mg TID (off label) |
GABA analog Treats alcohol withdrawal and possible anxiety related to alcohol craving. Also treats neuropathy |
No hepatic metabolism but needs renal adjustment LiverTox Grade: C (Probable cause of apparent liver injury) |
Meta-analysis (Kranzler, 2019)119 7 RCTs (N=730) Effect Size = 0.69 (to reduce heavy drinking days) |
Sedation Dizziness |
| Topiramate 75-400 mg QD (off label) |
GABA/glutamate modulator Inhibits alcohol-induced dopamine release to temper cravings. Also used for impulsivity and binge eating. |
Hepatic metabolism CYP 3A4 LiverTox Grade: C (Probable cause of apparent liver injury) |
Meta-analysis (Blodgett, 2014)120 7RCTs (N=1125) Effect Size = 0.47 (to prevent return to drinking) |
Parasthesias Weight loss Dizziness Cognitive slowing |