Alcohol dependence (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

For further information refer to:

Acamprosate, disulfiram and naltrexone are licensed for maintenance of abstinence after alcohol withdrawal.  Baclofen is also used [off-label] in the treatment of alcohol dependency. See http://www.choiceandmedication.org/nhs24/pdf/pillbaclofen.pdf.

Alcohol withdrawal: seek specialist advice:

Community:

Secondary Care:

For further information refer to:

  • NICE CG115 ‘Alcohol-use disorders’ at nice.org.uk. 

ACAMPROSATE

Therapy notes

  • Acamprosate treatment, in combination with counselling, should be initiated during or immediately after the alcohol withdrawal period.  Maintain treatment during relapse, unless clinical judgement is that acamprosate has led to no change in pattern of substance use.  The recommended period of treatment is one year.

Formulation and dosage details

Formulation:

Enteric coated tablets 333mg

Dosage:

18 to 65 years, 60kg and over, 666mg 3 times daily; less than 60kg, 666mg at breakfast, 333mg at midday and 333mg at night.

DISULFIRAM

Therapy notes

  • Warn those taking disulfiram, and their families and carers, about:
    • The interaction between disulfiram and alcohol (which may also be found in food, perfume, aerosol sprays etc), the symptoms of which may include flushing, nausea, palpitations and, more seriously, arrhythmias, hypotension and collapse.
    • The rapid and unpredictable onset of the rare complication of hepatoxicity; advise patients that if they feel unwell or develop a fever or jaundice that they should stop taking disulfiram and seek urgent medical attention.
  • In the initial stages of treatment, Community Nurse (Addictions) involvement is desirable. Follow specialist advice on monitoring and during treatment: monitor patients at least every 2 weeks for the first 2 months, then each month for the following 4 months, and at least every 6 months thereafter.
  • In order for this treatment to be successful the patient must be motivated; offer the information leaflet available at http://www.choiceandmedication.org. Maximum benefit is achieved with supervised treatment.

Formulation and dosage details

Formulation:

Tablets 200mg

Dosage:

200mg daily, should not be continued for longer than 6 months without review.  Only use a loading dose with specialist advice. Ensure that alcohol is not consumed for at least 24 hours before initiating treatment.

NALTREXONE

Therapy notes

  • Warn patients against use of opioids, eg in OTC cough medication and analgesics.

Formulation and dosage details

Formulation:

Tablets 50mg (s)

Dosage:

Relapse prevention in alcohol dependence in patients free of opioids, 50mg daily as a maintenance dose.  Check liver function before starting naltrexone and at 3-monthly intervals for one year. 

Editorial Information

Version: V1.2

Document Id: F104