Effectiveness and Adverse Events of Medications for Alcohol Use Disorder

Medications for the treatment of alcohol use disorder (AUD) can be effective and are underutilized, but there are limited data on the relative efficacy or adverse reactions among these medications, particularly for those that are newer or have been studied less.* Researchers conducted a meta-analysis of placebo-controlled randomized trials with durations of ≥4 weeks that examined outcomes of total abstinence, reduced heavy drinking,** and leaving studies due to adverse events. The meta-analysis included 156 trials with 27,334 participants.

  • For abstinence, the following medications were more effective than placebo: gamma hydroxybutyrate (relative risk [RR], 1.96), baclofen (RR, 1.93), disulfiram (RR, 1.77), extended-release naltrexone (RR, 1.64), topiramate (RR, 1.41), acamprosate (RR, 1.33), and oral naltrexone (RR, 1.19).
  • For heavy drinking, the following medications were more effective than placebo: disulfiram (RR, 0.19), baclofen (RR, 0.57), acamprosate (RR, 0.78), and oral naltrexone (RR, 0.81).
  • Of the medications that were effective for reducing heavy drinking, disulfiram (RR, 2.45) and oral naltrexone (RR, 1.47) caused more participants to leave studies due to adverse effects than placebo.

* In the US, the Food and Drug Administration (FDA)-approved medications for AUD are disulfiram, naltrexone, and acamprosate.

** Defined as consumption on 1 occasion of ≥5 standard drinks for men, ≥4 or more drinks for women.

Comments: This study finds that a range of medications are effective for the treatment of AUD. Remarkably, several medications that are not FDA-approved for AUD outperformed approved medications in the two drinking outcomes. Of the medications, only baclofen and acamprosate reduced both drinking outcomes and didn’t have adverse effects leading to study withdrawal. The side-by-side comparison of efficacy and adverse events using uniform study inclusion criteria may facilitate clinical decision-making and increase the use of these medications.

Timothy S. Naimi, MD, MPH

Reference: Bahji A, Bach P, Danilewitz M et al. Pharmacotherapies for adults with alcohol use disorders: A systematic review and network meta-analysis. J Addict Med. 2022;10.1097/ADM.0000000000000992.

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