Table 2. FDA-approved medications and other medications tested in clinical research settings (phase 2 or 3 medication trials) for the treatment of alcohol use disorder.
FDA, U.S. Food and Drug Administration; AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; NMDA, N-methyl-d-aspartate; PO, per os (oral); IM, intramuscular; HT, serotonin.
| FDA-approved medications for alcohol use disorder | ||
| Daily total dose |
Pharmacological mechanism(s) and additional information |
|
| Acamprosate (PO) | 1998 mg per day | Unclear—it has been suggested that acamprosate is a modulator of hyperactive glutamatergic states, possibly as an NMDA receptor agonist |
| Disulfiram (PO) | 250–500 mg per day | Inhibition of acetaldehyde dehydrogenase |
| Naltrexone (PO) | 50 mg per day | m-opioid receptor antagonist |
| Naltrexone (IM) | 380 mg once a month | m-opioid receptor antagonist |
| Not FDA-approved medications tested for alcohol use disorder | ||
| Baclofen (PO) | 30–80 mg per day | GABAB receptor agonist |
| Approved in France by the National Agency for the Safety of Medicines and Healthcare Products | ||
| Gabapentin (PO) | 900–1800 mg per day | Unclear—the most likely mechanism is blockade of voltage-dependent Ca2+ channels. Although it is a GABA analog, gabapentin does not seem to act on the GABA receptors |
| Nalmefene (PO) | 18 mg per day | m- and d-opioid receptor antagonist and k-opioid receptor partial agonist |
| Approved in Europe by the European Medicines Agency | ||
| Ondansetron (PO) | 0.5 mg per day (fixed dose) or up to 36 mcg/kg per day |
5HT3 antagonist |
| Prazosin/doxazosin (PO) | Up to 16 mg per day | a-1 receptor antagonists |
| Topiramate (PO) | Up to 300 mg per day | Topiramate is an anticonvulsant with multiple targets. It increases GABAA-facilitated neuronal activity and simultaneously antagonizes AMPA and kainate glutamate receptors. It also inhibits l-type calcium channels, limits the activity of voltage-dependent sodium channels and facilitates potassium conductance. Furthermore, it is a weak inhibition of the carbonic anhydrase isoenzymes, CA-II and CA-IV |
| Varenicline (PO) | 2 mg per day | Nicotinic acetylcholine receptor partial agonist |