Addiction Psychiatry - Pharmacological therapy for AUD
3 important questions on Addiction Psychiatry - Pharmacological therapy for AUD
Pharmacological outline for Acute Alcohol withdrawal
1. Benzodiazepine - Diazepam, chlordiazepoxide preferred; lorazepam in liver disease
2. Thiamine Vitamin B1 - Always give before glucose to avoid precipitating Wernicke’s
3.Carbamazepine/Epilim - May reduce seizure risk; helpful in dual diagnosis
4. Clonidine/Beta- Blockers
5. Haloperidol for severe agitation or hallucination
2. Thiamine Vitamin B1 - Always give before glucose to avoid precipitating Wernicke’s
3.Carbamazepine/Epilim - May reduce seizure risk; helpful in dual diagnosis
4. Clonidine/Beta- Blockers
5. Haloperidol for severe agitation or hallucination
Pharmacological Approach for Maintenance of Alcohol abstinence
Disulfiram 200-500mg/d - Aversion therapy
Naltrexone 50mg/d- Reduce psychological cravings
Acamprosate 333mg TDS- Maintain abstince
Topiramate 25-150mg/d - Reduce heavy drinking
Gabapentin 300mg/d reduce cravings , sleep aid
Baclofen 50-150mg/d - reduce cravings in liver disease
Naltrexone 50mg/d- Reduce psychological cravings
Acamprosate 333mg TDS- Maintain abstince
Topiramate 25-150mg/d - Reduce heavy drinking
Gabapentin 300mg/d reduce cravings , sleep aid
Baclofen 50-150mg/d - reduce cravings in liver disease
Evidence based guidelines for Pharmacological approach for Alcohol use
• NICE Guidelines (UK) and APA Practice Guidelines recommend pharmacological treatment in conjunction with psychosocial support.
• Meta-analyses support the efficacy of naltrexone and acamprosate in reducing relapse (Rosner et al., 2010; Jonas et al., 2014).
• NICE CG115 (2011): Acamprosate or naltrexone as first-line, disulfiram for those preferring aversion.
• Malaysia MOH Guidelines (CPG Management of Alcohol Use Disorders 2015): Also recommend naltrexone, acamprosate, disulfiram as pharmacological options post-withdrawal.
• Meta-analyses support the efficacy of naltrexone and acamprosate in reducing relapse (Rosner et al., 2010; Jonas et al., 2014).
• NICE CG115 (2011): Acamprosate or naltrexone as first-line, disulfiram for those preferring aversion.
• Malaysia MOH Guidelines (CPG Management of Alcohol Use Disorders 2015): Also recommend naltrexone, acamprosate, disulfiram as pharmacological options post-withdrawal.
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