| Nicotine |
Transdermal patch* |
11-22 mg 16- or 24 h delivery 6- to 12-week duration w/ taper |
Nicotine replacement therapy (NRT) |
Available over-the-counter (OTC) |
5,8-12 |
|
Polacrilex gum* |
2 or 4 mg 1 pc/1-2 h 6-to 12-week duration w/ taper |
NRT |
OTC Avoid acidic beverages |
6,8,14 |
|
Lozenge* |
2 or 4 mg 6 to 12 week duration w/ taper |
NRT |
OTC Do not chew, avoid acidic beverages |
6,8,13 |
|
Inhaler* |
1 mg/admin Each nostril Q 1-2 h 8-40 doses/day 8 weeks w/ taper wks 9-14 |
NRT |
Rapid delivery of nicotine, therefore some potential for abuse liability |
20,21 |
|
Nasal spray* |
0.013 mg nicotine/ puff 10 mg nicotine/ cartridge for 20 min of puffing 6-16 cartridges/day 12 weeks |
NRT |
Rapid delivery of nicotine, therefore some potential for abuse liability |
25,26 |
|
Bupropion* |
150 mg/day (7 d prior to quit date) 300 mg/day after 3-4 days |
Antidepressant |
2nd line: recommended to start prior to quit date; can be used in conjunction with NRT |
21,37 |
|
Nortryptylene |
25 mg TID-QID |
Antidepressant |
2nd line; toxicity in overdose amounts |
39,40 |
|
Clonidine |
0.1-0.3 mg/24-h ES patch 0.1-1.3 mg tablet |
Antihypertensive |
2nd line |
41-43 |
|
Selegiline |
5 mg BID cap 6-12 mg/24-h patch |
Antihypertensive; MAO-B inhibitor |
2nd line |
44-45 |
|
Varenicline* |
Titrate: 0.5 mg daily to 1 mg BID |
Partial agonist |
|
46 |
|
NicVAX |
** |
Nicotine vaccine |
Phase II clinical trials |
48 |
|
CYT002-NicOb |
** |
Nicotine vaccine |
Phase fib/Ill trial planned |
49,51 |
|
TA-NIC |
** |
Nicotine vaccine |
Phase II |
50 |
| Alcohol |
Chlordiazepoxide* |
50-100 mg IM/IV (may repeat in 2-4 h) |
Benzodiazepine |
Acute withdrawal |
54-55 |
|
Clonazepam* |
0,25 mg bid (max 4 mg/day) |
Benzodiazepine |
Acute withdrawal |
54-55 |
|
Diazepam* |
10 mg IM/IV, then 5-10 mg in 3-4 h prn |
Benzodiazepine |
Acute withdrawal |
54-55 |
|
Oxazepam* |
15-30 mg TID-QID |
Benzodiazepine |
Acute withdrawal |
54-55 |
|
Lorazepam* |
0.05 mg/kg IM 2 mg or 0.044 mg/kg IV2-3 mg BID tab |
Benzodiazepine |
Acute withdrawal |
54-55 |
|
Carbamazepine |
200 mg BID (Max 1200 mg/day) |
Anticonvulsant; antiepileptic |
Acute withdrawal, widely used |
56-59 |
|
Valproate |
15 mg kg/day (Max. 80 mg/kg/day) |
Anticonvulsant |
Acute withdrawal |
6 |
|
Disulfiram* |
250 mg/day (125 to 500 mg/day) |
Alcohol-sensitizing agent - inhibits enzymatic conversion of acetylaldehyde to acetic acid |
Relapse prevention and maintenance; subject should be motivated to quit |
60,61 |
|
Naltrexone* |
50 mg oral admin 12 weeks Extended release Q 4 wks |
Opioid receptor antagonist |
Relapse prevention and maintenance; mediates rewarding effects of alcohol |
68-70 |
|
Acamprosate* |
2g/3 x day (usual dose; 666 mg TID) |
Normalizes the dysregulation of NMDA-mediated glutaminergic excitation |
Relapse prevention and maintenance |
76,77 |
|
Topiramate |
25 mg BID (titrate weekly to 400 mg/day) |
Antiepileptic; GABA agonist |
Relapse prevention and maintenance |
78 |
|
Buspirone |
7.5 mg BID (titrate to 20-30 mg/day) |
Serotonin (5-HT)-1A agonist |
Relapse prevention and maintenance |
80 |
|
Fluoxetine |
6-25 mg/day 90 mg/week |
Selective serotonin uptake inhibitor (SSRI) |
Relapse prevention and maintenance |
82,85,87 |
|
Citalopram |
20 - 40 mg/day |
SSRI |
Relapse prevention and maintenance |
83,84,86,88 |
|
Ondansetron |
2 mg/mL, 32 mg/50 mL injection 4 mg/5 mL solution 4 - 24 mg tab |
5-HT3 antagonist; prevention of nausea/vomiting |
Relapse prevention and maintenance |
81 |
| Cocaine |
Disulfiram (Antabuse) |
250 mg/day |
Nonspecific enzyme inhibitor including aldehyde dehydrogenase and dopamine beta hydroxylase |
Good efficacy data in nonakoholics, relatively contraindicated in alcohol dependence with cocaine |
92,93 |
|
Selegiline |
5 mg BID cap 6-12 mg/24 h patch |
Antihypertensive; MAO-B inhibitor |
|
37-99 |
|
Desipiramine |
100-200 mg/day (max 300 mg/day) |
Antidepressant |
|
6,100,101 |
|
Baclofen |
40-80 mg/day |
GABA agonist |
Additive CNS effects w/ alcohol |
109 |
|
Tiagabine |
4 mg/day (may increase to max 56 mg/day) |
Anti-seizure; GABA agonist |
Additive CNS depression w/ alcohol |
110,111 |
|
Topiramate |
25 mg bid (titrate weekly to 400 mg/day) |
Antiepileptic/antiseizure; GABA agonist |
Potentiates CNS depression w/ alcohol; withdraw gradually |
112 |
|
Vigabatrin |
** |
GABA agonist |
|
113 |
|
Carbamazepine |
200 mg BID (Max 1200 mg/day) |
Anticonvulsant; Antiepileptic |
Inconsistent results from clinical trials |
114,115 |
|
Buprenorphine |
8 mg sublingual (liquid) 1 mg tablet 4:1 combination sublingual tablet w/ naloxone (Suboxone) |
Partial agonist at mu-opioid receptor |
Inconsistent results from clinical trials; low abuse potential |
116,119 |
|
Amantadine |
200 ing/day |
Dopamine & NMDA agonist |
inconsistent results from clinical trials; potential use in severe withdrawal |
120-123 |
|
Modafinil |
200 mg/day |
Wakefulness-promoting agent |
Low abuse potential; often used for many off-label indications |
124,125 |
|
TA-CD |
** |
Cocaine vaccine |
Phase II trials; must be motivated to quit |
129-131 |
| Opiates |
Methadone* |
30-100 mg/daily (initial doses 15 to 20 mg/day) >100 mg/day in persistent heroin abuse or comorbid conditions |
mu-opioid agonist |
Gold standard for opioid maintenance treatment |
138-144 |
|
Buprenorphine* |
8 mg sublingual (liquid) 1 mg tablet 4:1 combination sublingual tablet w/ naloxone (Suboxone) |
Partial agonist at mu-opioid receptor & kappa antagonist |
Injection of suboxone could precipitate opiate withdrawal |
147-152 |
|
Naltrexone |
50 mg oral admin* Depot: extended release |
Nonspecific opioid antagonist |
Few side effects but monitor liver function; must be opiate free for 7 to 10 days prior to initiation |
154-157 |
