1- What are my medication options for Alcohol use disorder?
There are 3 FDA options most prescribers use:
1- Naltrexone (Vivitrol, Revia)
Naltrexone is an “antagonist.” It works by blocking the mu-opioid receptor. Alcohol is thought to indirectly stimulate the opioid receptors leading to reinforcing (pleasurable) effects. Naltrexone is thought to block this pleasurable effect and therefore help alcohol addiction. People do get fewer cravings for alcohol while on the medication
2- Acamprosate (Campral)
Acamprosate works by restoring the balance between GABA and NMDA. Chronic alcohol use changes the balance between two important receptors in the brain involving addictions (GABA and NMDA). This medication restores the balance between this. Because of this, the cravings help with post-acute withdrawal symptoms
3- Disulfate (Antabuse)
Disulfiram (Antabuse) works by blocking the enzyme called Acetaldehyde dehydrogenase (ALDH). By doing this alcohol metabolism is stuck on acetaldehyde. Acetaldehyde acts as a poison, so if you take this medication and then alcohol you will get uncomfortable side effects.
4- Topiramate
Topiramate (Topamax) is a medication commonly used in neurology and psychiatry for headaches, mood stabilization, and more. With benzodiazepine (e.g. Xanax, Ativan) addiction research, Topiramate is shown to be effective in increasing sobriety likely by decreasing glutamate, a neurotransmitter in the brain that leads to anxiety/restlessness. It is thought this anxiety and restlessness is a reasons for relapses to occur