Drugs for alcohol dependence

Abstract

There is good evidence for the use of pharmacological treatments to improve outcomes in patients with alcohol dependence. The management of acute withdrawal should include a high risk of suspicion for Wernicke–Korsakoff syndrome, necessitating treatment with parenteral thiamine. Benzodiazepines in reducing doses should be used in conjunction with a continuing treatment plan after medically assisted withdrawal (detoxification). The relapse prevention medications acamprosate and naltrexone should be considered in all patients with moderate to severe alcohol dependence wishing to maintain abstinence. Disulfiram can be considered as a second-line treatment, but should be initiated by a specialist. Nalmefene has been shown to be effective in patients with mild dependence wishing to reduce their alcohol consumption. Baclofen remains off licence in much of the world: it may have a role in patients with co-morbid liver disease and anxiety symptoms.