Table 6.

Select Effects of Medications on Drinking Outcomes

Medication	Drinking Outcome	Effect estimate	Source	Factors Influencing Medication Choice
		(95% CI or p-value)
Naltrexone	Heavy drinking day (≥ 60 grams alcohol)	Relative risk 0.83	Meta-analysis of 50	Avoid in patients with opioid abuse or use; caution in liver disease and advanced kidney disease
		(0.76-0.90)	randomized controlled trial (RCT’s) [87]
Acamprosate	Any drinking	Relative risk 0.86	Meta-analysis of 24	Avoid with advanced kidney disease (e.g., creatinine clearance < 30 ml/min)
		(0.81-0.91)	RCT’s [86]
Disulfiram	Any drinking	Slight majority of trials found improved abstinence.	Review of 11 RCT’s [85]	Avoid if alcohol-disulfiram reaction medically dangerous; number of medical conditions associated with accidental reaction; avoidance of alcohol-containing products
Topiramate*	% heavy drinking days	8.4% reduction	Multicenter RCT [83]	Caution with advanced liver or kidney disease; risk for metabolic acidosis with predisposing conditions; avoid abrupt discontinuation
		(3.1-13.8)
Ondansetron*	Average number of drinks on days alcohol was consumed	If alcoholism onset before age 25, 4.28 relative to 6.9 in placebo(p=0.004)	RCT [84]	Not shown to be beneficial for later-onset alcohol dependence; may prolong QT interval

*Not FDA-approved for treating alcohol dependence.