topiramate

Bottom line
Older, small randomized controlled trials (RCTs) show that propranolol reduces tremor severity (about 2 points more than placebo on 10- to 15-point scales) and leads to patients feeling “definitely better” in 64% to 100% versus 14% to 20% (placebo) at 2 to 6 weeks. Benefit is seen from 90 mg/day, with 120 to 240 mg/day most studied. Primidone and topiramate may improve function based on limited RCTs.

Author/s:

Allison Paige, Samantha S. Moe

Anticraving medication for moderate to severe alcohol use disorder

Saige Blanchard — Tue, 11 May 2021 05:00:00 +0000

Date Added:

May 11, 2021

Journal/Publication:

CMAJ Joule Inc.

Publisher:

CMAJ Joule Inc.

Publication Date:

May 10, 2021

URL:

Anticraving medication for moderate to severe alcohol use disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1503/cmaj.200895

Keywords

MeSH

Cognitive Behavioral Therapy

A concise summary of treatment options for alcohol use disorders.

James W. Mold, MD, MPH

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Alcohol use disorder is characterized by compulsive use, lack of control and harmful consequences of alcohol. Men who have had more than 5 standard drinks and women who have had more than 4 standard drinks on 1 occasion within the past year should be assessed for alcohol use disorder.1 Anticraving medications can play an effective role in overcoming moderate to severe alcohol use disorder and can be prescribed by primary care physicians.

Author/s:

Mong, J., Ahamad, K., Bach, P.

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review

Jeffrey Wilson — Thu, 27 Dec 2018 16:24:11 +0000

Date Added:

December 27, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

August 28, 2018

Issue:

Volume:

320

Pages:

815-824

URL:

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.11406

Keywords

alcohol

alcoholism

pharmacogenetics

PMID (1):

30167705

MeSH

This is a 5-part series of reviews pertaining to the treatment of patients with alcohol use disorders.

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IMPORTANCE:

Alcohol consumption is associated with 88 000 US deaths annually. Although routine screening for heavy alcohol use can identify patients with alcohol use disorder (AUD) and has been recommended, only 1 in 6 US adults report ever having been asked by a health professional about their drinking behavior. Alcohol use disorder, a problematic pattern of alcohol use accompanied by clinically significant impairment or distress, is present in up to 14% of US adults during a 1-year period, although only about 8% of affected individuals are treated in an alcohol treatment facility.

OBSERVATIONS:

Four medications are approved by the US Food and Drug Administration to treat AUD: disulfiram, naltrexone (oral and long-acting injectable formulations), and acamprosate. However, patients with AUD most commonly receive counseling. Medications are prescribed to less than 9% of patients who are likely to benefit from them, given evidence that they exert clinically meaningful effects and their inclusion in clinical practice guidelines as first-line treatments for moderate to severe AUD. Naltrexone, which can be given once daily, reduces the likelihood of a return to any drinking by 5% and binge-drinking risk by 10%. Randomized clinical trials also show that some medications approved for other indications, including seizure disorder (eg, topiramate), are efficacious in treating AUD. Currently, there is not sufficient evidence to support the use of pharmacogenetics to personalize AUD treatments.

CONCLUSIONS AND RELEVANCE:

Alcohol consumption is associated with a high rate of morbidity and mortality, and heavy alcohol use is the major risk factor for AUD. Simple, valid screening methods can be used to identify patients with heavy alcohol use, who can then be evaluated for the presence of an AUD. Patients receiving a diagnosis of the disorder should be given brief counseling and prescribed a first-line medication (eg, naltrexone) or referred for a more intensive psychosocial intervention.

Author/s:

Kranzler, Henry R., Soyka, Michael