Substance use/Alcohol Dependency

Question 1

Acamprosate (Campral)

Answer 1

Use: ETOH maintenance
- No alcohol within 12 hours
- Good for chronic daily drinker
- Good for goal of complete abstinence
- Not for reduced risk drinking, binge drinking

Dose:
- 666 mg three times a day
(no taper needed)
- < 60 kg take twice daily
- 333 mg tabs

Side effects:
- Contraindicated severe renal impairment
- Hepatic impairment does NOT require dosage
changes
● SE: diarrhea, nausea, anxiety, depression
● No alcohol within 12 hours
● Baseline & follow up LFTs
● Not indicated severe renal/hepatic impairment,
no cardiac

Question 2

Disulfiram (Antabuse)

Answer 2

Use: Alcohol dependance tx/maintenance of
abstinence
- No alcohol within 12 hours
- No metronidazole, amprenavir,
ritonavir, or sertraline

Dose:
- Start 250 mg, max 500 mg
- Dose in am, can be taken
at night if sedating
- 250, 500 scored tabs

Side effects:
- Effects are immediate- will make sick if
drinking
● Baseline & follow up LFTs
● Not indicated severe renal/hepatic impairment,
no cardiac

● SE: metallic taste, sedation, flushing,
headache, nausea

Question 3

Naltrexone (Vivitrol)

Answer 3

Use: Alcohol maintenance
● Good for binge drinkers
● Not ready for abstinence

Dose:
- Start 50 mg day
No titration
-Opiate dependence- 25 mg BID

Side effects:
- Opiate free 5-7 days
● Can reduce heavy drinking days
● Less effective if not abstinent during initation