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Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 May. Report No.: 14-EHC029-EF.
In people with alcohol-use disorders, do any medications reduce alcohol use? Do the effective medications have side-effects?
Alcohol-use disorders can range from drinking more than the recommended amounts to alcohol dependence. Alcohol-use disorders increase risk of death, disease (e.g., heart disease, stroke, cancer, high blood pressure, cognitive impairment, decreased bone density), and accidents.
There are many treatments for alcohol-use disorders, including cognitive-behavioural therapy, 12-step programs (e.g., Alcoholics Anonymous), and medications. However, there is no evidence that one treatment approach works better than the others.
The researchers did a systematic review based on studies available up to October 2013.
They found 135 studies, including 124 randomized controlled trials, 5 observational studies, and 6 systematic reviews.
Key features of the studies were:
The quality of evidence varied. Findings for drinking outcomes that are based on moderate-strength evidence are reported here, with accompanying with side-effects.
Compared with placebo, acamprosate (Campral®):
Compared with placebo, naltrexone (ReVia®), 50 mg orally:
Compared with naltrexone (ReVia®), 50 mg orally, acamprosate (Campral®):
In people with alcohol-use disorders, acamprosate (Campral®) and naltrexone (ReVia®) reduce alcohol use and have minor side-effects.
Medication and comparison | Outcomes | Number of studies (people) | Effects of medication |
Acamprosate (Campral®) vs placebo | Return to any drinking | 16 (4,847) | 9% less likely to return to any drinking (as little as 4% and as much as 14% difference) |
| Return to heavy drinking | 7 (2,496) | No difference |
| Drinking days | 13 (4,485) | 9% fewer days of drinking (as little as 5% fewer and as many as 13% fewer) |
Naltrexone (ReVia®) (50 mg orally) vs placebo | Return to heavy drinking | 19 (2,875) | 9% less likely to return to heavy drinking (as little as 4% and as much as 13% difference) |
| Drinking days | 15 (1,992) | 5% fewer days of drinking (as little as 3% fewer and as many as 8% fewer) |
| Heavy drinking days | 6 (521) | 4% fewer days of heavy drinking (as little as 1% fewer and as many as 8% fewer) |
Acamprosate (Campral®) vs naltrexone (ReVia®) | Return to any drinking | 3 (800) | No difference |
| Return to heavy drinking | 4 (1,141) | No difference |
*Includes evidence of moderate strength (evidence of low or insufficient strength is excluded).