Alcohol addiction - the safety of available approved treatment options

ABSTRACT

Introduction: Alcohol Use Disorders (AUD) is a leading cause of mortality and morbidity worldwide. At present disulfiram, naltrexone and acamprosate are approved for the treatment of AUD in U.S. and Europe. Nalmefene is approved in Europe and sodium oxybate is approved in Italy and Austria only. Baclofen received a ‘temporary recommendation for use’ in France.

Areas covered: The safety of the above mentioned medications on liver, digestive system, kidney function, nervous system, pregnancy and lactation and their possible side effects are described and discussed.

Expert opinion: Mechanism of action and metabolism of these drugs as well as patients’ clinical characteristics can affect the safety of treatment. All approved medications are valid tools for the treatment of AUD in patients without advanced liver disease. For some drugs, attention should be paid to patients with renal failure and medications may be used with caution, adjusting the dosage according to kidney function. In patients with AUD and advanced liver disease, at present only baclofen has been formally tested in randomized controlled trials showing its safety in this population.

KEYWORDS:

• Alcohol
• alcohol dependence
• AUD
• craving
• safety

Article highlights

• AUD is a critical public health issue associated with high mortality and morbidity

• There are behavioral and pharmacological treatments that are available to treat patients with AUD

• Medications should be used taking into account the clinical characteristics of each patient

• The safety profile and the side effects of the pharmacological treatments depend on their mechanism of action and metabolism as well as by patients’ clinical characteristics

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work was partially supported by the Italian Ministry for University, Scientific and Technological Research (MURST) [2013-2014-2015-2016-2017]. However, the authors have the full responsibility for the contents written in this paper.