Anticraving therapy for alcohol use disorder: A clinical review

Abstract

Aim: In this review, the author focused on anticraving therapy for alcohol use disorder (AUD) defined by DMS-5. A comprehensive review was carried out on the available published papers on anticraving drugs for treating AUD patients.

Methods: The author described all drugs with anticraving benefits for treating AUD patients approved by the Food and Drug Administration of the United States (US FDA) and European Medicines Agency of the European Union. Then, the commonly prescribed anticraving drugs and those under development were also described.

Results: The US FDA-approved anticraving drugs included acamprosate and naltrexone, and those approved by European Medicines Agency were gamma-hydroxybutyrate and nalmefene. The author also highlighted topiramate, gabapentin, ondansetron, LY196044, ifenprodil, varenicline, ABT-436, mifepristone, citicoline, and baclofen. The putative mechanisms of action of and the use in clinical practice of those anticraving drugs were also described.

Conclusion: Although slowly developing, the field of anticraving drugs is getting into shape as a promising entity of a pharmaceutical class of drugs. Then, the author addressed on the underused issues of those recommended, and suggested anticraving drugs by the practice guideline of the American Psychiatric Association. The author urges that clinicians should be more "adventurous" in prescribing those promising drugs because benefits of those anticraving drugs are far-outweighing the possible side effects of anticraving drugs, or the harms of untreated AUD itself.

Keywords: acamprosate; gabapentin; gamma-hydroxybutyrate; ifenprodil; nalmefene; naltrexone; topiramate.

Figure 1

Schematic illustration depicting how alcohol* acts on endogenous opioid system. Originally, the word “opioids” is a term denoting synthetic narcotics resembling opiates but increasingly used to refer to both opiates (produced from opium) and synthetic narcotics