Alcohol Rehab

Question 1

Naltrexone

Answer 1

Alcohol Rehab
FDA-approved Indications
─ Alcohol dependence
─ Opioid dependence
MOA
─ Reversible opioid antagonist
─ Prevents effects of endogenous opioids when consuming alcohol
ADE
─ GI intolerance, injection reactions
─ Hepatic impairment—baseline LFTs

Question 2

Disulfiram

Answer 2

Alcohol Rehab
─ preferred in legally mandated or highly motivated people
─ Can be used intermittently in high-temptation situational
(ex: Wedding)

FDA- approved Indications
─	Maintenance of alcohol abstinence
MOA
─ Aldehyde dehydrogenase antagonist
─ **“aversive therapy”
ADE
─ Metallic taste, drowsiness, visual changes, hepatic impairment
─ *Acetaldehyde toxicity
─ Esp Avoid in PTs with psychiatric or heart disease
D/I
─ Alcohol and any Med formulated in alcohol (ex: Mouthwash)
─ *Metronidazole: additive CNS effects

Question 3

Acamprosate

Answer 3

Alcohol Rehab
FDA-approved Indications
─ Maintenance of alcohol abstinence
MOA: Unknown
─ Likely: blockade of NMDA receptor → ↓s Glutamate hyperexcitability during abstinence 
─ and/or GABA enhancement.
ADE
─ GI effects
─ Insomnia, anxiety, and sleep changes
D/I
- caution in severe Renal impairment