Table 2.

Comparison of the three medications currently approved by the FDA for the treatment of alcohol dependence.

	Acamprosatea	Naltrexoneb	Disulfiramc
Mechanism of action	Restores balance between excitatory glutamate and inhibitory GABA neurotransmitter systems	Opioid receptor antagonist	Inhibits alcohol dehydrogenase, a key enzyme in alcohol metabolism
Interactions with alcohol	None	None	Severe adverse reaction includes nausea, vomiting, flushing, tachycardia
Drug interactions	No clinically significant interactions	Opiates	Phenytoin, oral anticoagulants, isoniazid
Common side-effects	Diarrhea, asthenia, nausea, pruritis, flatulence	Elevated liver function tests, nausea, headache, dizziness, nervousness, fatigue, insomnia, vomiting	Hepatitis, occasional skin eruptions, transient mild drowsiness, fatigueability, impotence, headache
Serious adverse events	None known	Hepatitis	Hepatitis, optic neuritis, peripheral neuritis, polyneuritis and peripheral neuropathy
Contraindications	Severe renal impairment	Hepatitis or liver failure	Hepatitis or liver failure. Current use of metronidazole, paraldehyde, alcohol, or alcohol-containing preparations.

^aForest Pharmaceuticals, Inc. 2005

^bRiVea (naltrexone hydrochloride) Tablets patient package insert (Mallinckrodt 2005).

^cAntabuse (disulfiram) Tablets patient package insert (Odyssey Pharmaceuticals, Inc. 2005).

Abbreviations: GABA, gamma-aminobutyric acid.