Safety and Tolerability of Pharmacological Treatment of Alcohol Dependence:
Comprehensive Review of EvidenceAbstract
Alcohol use disorders (AUD) cause significant morbidity and mortality worldwide, but
pharmacological treatments for them are underused, despite evidence of efficacy.
Acamprosate, naltrexone, nalmefene and disulfiram are all approved in one or more region
for the treatment of AUD. Baclofen currently has a temporary indication in France. Safety
considerations for using psychopharmacological treatments in this patient group include the
impact of concurrent alcohol consumption at high levels; multiple physical comorbidities
that may interfere with pharmacological effects, distribution and metabolism; and
concomitant medication for the treatment of comorbid physical and psychiatric conditions.
The five drugs, including an extended-release injectable suspension of naltrexone, have
different safety profiles that need to be balanced with the treatment objective (initiation or
continuation of abstinence, or reduction of drinking), individual patient preferences and
comorbid conditions. Appropriate treatment will be based on the unique risk–benefit profile
in each case.
