Medications for Alcohol Use Disorder: Treatment Approaches and Options
Explore the various medications used in treating Alcohol Use Disorder, including Mu-opioid receptor antagonists, Acamprosate, Gabapentin, and Antabuse. Learn about their mechanisms, dosages, and precautions for effective management of AUD.
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Presentation Transcript
MEDICATIONS FOR ALCOHOL USE DISORDER David Mendez MD FASAM Addiction Medicine
CDC: 52.8% of adults over 18 regularly consume alcohol 10% of adults over 18 with AUD in past year <10% of adults with AUD report treatment Alcohol associated liver deaths: 30,910 Alcohol induced deaths: 51,191
BASICS OF ADDICTION Mesolimbic pathway VTA -> nucleus accumbens, amygdala, hippocampus Dopamine Endocannabinoid system Endogenous opioid system
DIAGNOSIS OF A SUBSTANCE USE DISORDER Social impairment Pharmacological properties Impaired control Risky use Used in larger amounts or longer than intended Unsuccessful efforts to cut back Excessive amount of time obtaining or using Craving Failure to fulfill work/school/home obligation Persistent social or interpersonal problems Reduced or given up social, occupation or recreational activities Using in physical hazardous situations Persistent use despite physical or psychological problems Tolerance Withdrawal
Mu opioid receptor antagonist Decrease in cravings and heavy drinking days XR: vivitrol Do not use in decompensated cirrhosis or severe alc hep Sinclair method NALTREXONE
ACAMPROSATE Modulates glutamate receptors; increases GABA-ergic system and decrease glutamate May be helpful with PAWS TID dosing Dose adjustment with GFR 30-50 (333mg TID); avoid in <30
Binds to voltage gated calcium channels and modulates release of excitatory neurotransmitters May be helpful with PAWS and anxiety GABAPENTIN TID dosing
Blocks breakdown of acetaldehyde Avoid in liver disease May be used intermittently during high risk situations ANTABUSE
SEMAGLUTIDE GLP1 agonist Some data suggesting decrease in cravings and consumption of alcohol
HARM REDUCTION Motivational interviewing Daily vitamin Glass of water between beverages Three daily meals
