ALCOHOL
The FDA has approved three medications for treating alcohol addiction.[1] Naltrexone reduces cravings and relapse by blocking receptors in the brain, Acamprosate (sold as Campral) reduces the symptoms of withdrawal, and Disulfiram (sold as Antibuse) acts as a deterrent by stopping the breakdown of alcohol.
- Naltrexone
Brand names: Vivitrol (extended-release injection ) ReVia (oral tablet)
Administered: extended-release injection every 4 weeks or oral tablet
How It Works: Naltrexone works by reducing your urge to drink alcohol. This may help you drink less or stop drinking completely.
Clinical Benefits: Research has confirmed that naltrexone can reduce alcohol cravings and decrease relapse rates when used in combination with psychosocial therapy.[2]
Potentially Severe Side Effects: Call your doctor at once if you have: severe nausea, vomiting, or diarrhea; mood changes, confusion, hallucinations (seeing or hearing things); depression, thoughts about suicide or hurting yourself; or liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Common Side Effects: nausea, headache, dizziness, anxiety, fatigue, insomnia
Availability: by prescription
- Acamprosate
Brand Name: Campral, Campral EC
Administered: oral tablet
How It Works: Acamprosate works by restoring this chemical balance in an alcohol-dependent person who has recently quit drinking. When used with behavior modification and counseling support it may help you choose not to drink.
Clinical Benefits: A review of multiple European studies found that acamprostate is moderately effective in maintaining alcohol abstinence, doubling the length of time before relapse when compared with a placebo. [3]
Potentially severe side effects: Call your doctor at once if you have: severe anxiety or depression; mood or behavior changes; thoughts of suicide or hurting yourself; swelling in your hands or feet; or pounding heartbeats or fluttering in your chest.
Common Side Effects: diarrhea, dizziness, flatulence, itchiness, loss of appetite, nausea, insomnia, weakness
Availability: by prescription
- Disulfiram
Brand Name: Antabuse
Administered: oral tablet
How it works: Disulfiram stops the enzymes (chemicals in your body) that break down alcohol, resulting in unpleasant effects that include nausea, headache, high-blood pressure, and sweatiness. Even small amounts of alcohol from products like mouthwash or cough medicine may produce unpleasant symptoms when taking Antabuse.
Clinical Benefits: A recent review of over 60 years of studies involving disulfiram concluded that the drug does have a positive effect on alcohol abstinence, including preventing relapse. [4]
Potentially severe side effects: Call your doctor at once if you have eye pain or sudden loss of vision; confusion, unusual thoughts or behavior; or liver problems
Common Side Effects: drowsiness, headache, impotence, acne, metallic taste
Availability: by prescription
OPIOID
Medication is one of the most effective treatments for opioid use disorder.[5] Methadone can be administered daily by a licensed treatment clinic, while Buprenorphine and Naltrexone can be administered by a physician. Naloxone can be administered in an emergency to reverse an overdose.
- Naloxone
Brand name: Narcan Nasal Spray, Narcan Injection or Evzio
Administered: injection or through nasal spray
How it works: Opioids slow breathing. If breathing stops completely, naloxone works to counteract the opioids to allow the patient to breathe normally.
Clinical Benefits: Naloxone is on the World Health Organization’s Model List of Essential Medicines,[6] and decades of research have shown it to be safe and effective at reversing overdose.[7] In fact, since 2012, bystanders in the US have reversed more than 10,000 opioid overdoses using naloxone.[8]
Common Side Effects: chest pain, seizures, allergic reaction like hives, trouble breathing, or swelling of the face, lips or tongue
Availability: Varies by state; Visit http://www.getnaloxonenow.org/GetNaloxone.aspx for more information
- Methadone
Brand Name: Dolophine or Methadose
Administered: oral tablet, liquid, wafer, or injection – must be administred at an approved clinic
How it works: Methadone blocks the pleasurable effects of opioids, preventing the “high” feeling and reducing cravings.
Clinical Benefits: Research shows methadone is effective at the treatment of substance abuse disorders involving heroin or other opioids. Methadone treatment reduced narcotics use and criminal behaviors and is relatively low-cost compared with other treatments.[9]
Potentially serious side effects: Call your doctor at once if you have: weak or shallow breathing; severe constipation; a light-headed feeling, like you might pass out; infertility, missed menstrual periods; impotence, sexual problems, loss of interest in sex; symptoms of a life-threatening heart rhythm disorder - a headache with chest pain and severe dizziness, and fast or pounding heartbeats; or low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Methadone is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.
Common Side Effects: anxiety, insomnia, weakness, drowsiness, restlessness, dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite, sexual issues including impotence, decreased sex drive, and difficulty having an orgasm
Availability: by prescription, to be administered at a licensed facility only; Visit http://www.methadone.us/methadone-clinics/ for more information
- Buprenorphine
Buprenorphine works like opioids, attaching to receptors in the brain, but without the pleasurable effect. In essence, it “tricks” the brain to feel satisfied. Additionally, because it “fills” the receptors, any opioids that are used have no place to attach and therefore have no effect.
Clinical Benefits: A systemic review of research conducted about the effects of buprenorphine found that it’s more effective at reducing opioid use than a placebo.[10] Patients also reported fewer withdrawal symptoms when taking buprenorphrine.[11]
Buprenorphine treatment happens in three phases27:
- The Induction Phase is the medically monitored startup of buprenorphine treatment performed in a qualified physician’s office using approved buprenorphine products. The medication is administered when a person with an opioid dependency has abstained from using opioids for 12 to 24 hours and is in the early stages of opioid withdrawal. It is important to note that buprenorphine can bring on acute withdrawal for patents who are not in the early stages of withdrawal and who have other opioids in their bloodstream.
- The Stabilization Phase begins after a patient has discontinued or greatly reduced their misuse of the problem drug, no longer has cravings, and experiences few, if any, side effects. The buprenorphine dose may need to be adjusted during this phase. Because of the long-acting agent of buprenorphine, once patients have been stabilized, they can sometimes switch different formulations (e.g. implant) or less frequent dosing. This decision should be made in conjunction with a healthcare professional as each patient’s needs may be very different.
- The Maintenance Phase occurs when a patient is doing well on a steady dose of buprenorphine. The length of time of the maintenance phase is tailored to each patient and could be indefinite.
- Buprenorphine and Naloxone
Brand name: Suboxone, Zubsolv, and Bunavail
Administered: oral film strip, sublingual tablet (placed under the tongue) or transmucosally though the cheek
How it works: Buprenorphine attaches to the receptors in the brain without the pleasurable effects of opioids, tricking the brain into feeling satisfied. Naloxone is an opioid blocker, and like buprenorphine occupies the brains receptors so opioids have no effect.
Common Side Effects: numbness and tingling, drowsiness, insomnia, stomach pain, headache, dizziness, constipation, vomiting, stomach pain, pain or numbness in the mouth, difficulty concentrating
Clinical Benefits: A 2011 study showed that participants who took Suboxone for 12 weeks reduced prescription painkiller use by 49%. After they stopped taking Suboxone, the rate dropped to 8.6%.[12]
Availability: by prescription from licensed doctors only; Visit http://www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator for more information
- Buprenorphine implant
Brand Name: Probuphine
Administered: implant
How it works: Buprenorphine implant (placed under the skin) is used for maintenance treatment of opioid dependence in patients who have achieved stability on oral forms of buprenorphine treatment. Probuphine should be used as part of a complete treatment program including counseling and behavioral therapy25.
- Potential Serious Side Effects: Serious complications may happen from insertion and removal of PROBUPHINE, including:
- Nerve or blood vessel injury in your arm
- Movement of implant (migration). PROBUPHINE or pieces of it can move into blood vessels and to your lung, and could lead to death.
- Implant sticks out of the skin (protrusion)
- Implant comes out by itself (expulsion)
- Call your healthcare provider right away if:
- PROBUPHINE sticks out of the skin or comes out by itself
- You have bleeding or symptoms of infection at the site after insertion or removal, including excessive or worsening itching, pain, irritation, redness, or swelling
- You have numbness or weakness in your arm after the insertion or removal procedure
- You have weakness or numbness in your arm, or shortness of breath
Common Side Effects: dizziness, headache, drowsiness, nausea, constipation, sedation
Availability: by prescription from licensed and trained doctors only; Visit http://probuphine.com/probuphine-physician-locator/ for Probuphine implant information
- Naltrexone
Brand Names: ReVia, Depade, and Vivitrol
Administered: oral tablet or monthly injection
How it works: Naltrexone is an opioid blocker, attaching to receptors in the brain without activating them. As a result, opioids cannot attach to the brain receptors and have no effect.
Clinical Benefits: Clinical studies show that naltrexone sold as Vivitrol is non-addictive, safe, and effective at reducing opioid dependence and withdrawal symptoms for patients who stick with the treatment.[13]
Common Side Effects: nausea, headache, dizziness, anxiety, fatigue, trouble sleeping
Availability: by prescription
TOBACCO
One of the most popular treatments for tobacco addiction, nicotine replacement therapies can be purchased over the counter and include the patch, gum, inhalers, lozenges, and other forms. Additionally, two FDA approved prescriptions medications are available[14]: bupropion, sold as Zyban®, and varenicline, sold as Chantix® - both of which affect the brain’s neurotransmitters to block cravings.
- Nicotine replacement therapies
Brand Names: Commit, Habitrol, Nicoderm CQ, Nicorette, Nicotrol
Administered: transdermally (patch) or orally (gum, lozenge, or inhaler)
How it works: Nicotine replacement therapy supplies the body with nicotine at reduced levels, weaning the user off nicotine slowly to reduce withdrawal symptoms.
Common Side Effects: tingling feeling on the tongue, hiccups, upset stomach (gum); upset stomach, hiccups, flatulence, heartburn, headache (lozenge); rash, trouble sleeping (patch); cough, sore throat, upset stomach (inhaler)
Clinical Benefits: Studies show that when people who are attempting to quit smoking include some kind of nicotine replacement therapy, they double the chance for success.[15]
Availability: patches, gum, and lozenges over the counter; inhalers by prescription
- Bupropion
Brand Name: Zyban
Administered: oral tablet
How it works: Although specifics are unclear, bupropion alters the levels of chemicals in the brain’s neurotransmitters, which seems to affect withdrawal symptoms and nicotine cravings.
Clinical Benefits: Multiple research studies have shown that bupropion is roughly 20% effective at helping those with a tobacco use disorder quit smoking, [16]
Common Side Effects: dry mouth, difficulty sleeping
Availability: by prescription
- Varenicline
Brand Name: Chantix
Administered: oral tablet
How it works: Varenicline affects the brain’s neurotransmitters to block the pleasurable effects of nicotine, reducing cravings and withdrawal symptoms
Clinical Benefits: A recent study shows Chantix is more effective than nicotine replacement therapy for the cessation of smoking, and 47% of users who took Chantix reduced smoking by more than half.[17]
Common Side Effects: nausea, vomiting, unusual dreams, constipation, drowsiness
Availability: by prescription
The use of medication can be an instrumental part of a substance use disorder treatment plan. Remember, medications are generally most effective when used in combination with other interventions like behavioral therapy and counselingt[18]. Use the information here to talk with your physician or clinician about medication-assisted treatments when you’re deciding upon a comprehensive treatment for recovery.
ALL DRUG AND SIDE EFFECT INFORMATION PROVIDED BY:
http://www.rxlist.com/script/main/hp.asp
http://www.webmd.com/drugs/index-drugs.aspx?show=drugs
[1] National Institute on Alcohol Abuse and Alcoholism. http://pubs.niaaa.nih.gov/publications/treatment/treatment.htm#chapter04 “What FDA-Approved Medications Are Available?”
[2] O'Malley et al., 1992;Volpicelli, Alterman, Hayashida, & O'Brien, 1992; Volpicelli, Watson, King, Sherman, & O'Brien, 1995
[3] Bouza, Magro, Muñoz, & Amate, 2004
[4] Open Journal of Psychiatry, 2014, 4, 43-52 OJPsych http://dx.doi.org/10.4236/ojpsych.2014.41007 Published Online January 2014 (http://www.scirp.org/journal/ojpsych/)
[5] Substance Abuse and Mental Health Services Administration. “Medication Assisted Treatment for Opioid Addiction: Facts for Friends and Family.” HHS Publication No. (SMA) 09-4443. 2011
[6] World Health Organization. (2009). WHO Model List of Essential Medicines. 16th List. Online at: http://www.who. int/medicines/publications/essentialmedicines/en/.
[7] Evans J.M., Hogg M.I., Lunn J.N., Rosen M. (1974). Degree and duration of reversal by naloxone of effects of morphine in conscious subjects. British Medical Journal; 15:2.
[8] Wheeler, E., Davidson, P.J., Jones, T.S., Irwin, K.S. (2012). Community-based overdose prevention programs providing naloxone—United States, 2010. Morbidity and Mortality Weekly Report. Atlanta: Centers for Disease Control and Prevention.
[9] Powers and Anglin, 1993, National Institute of Drug Abuse Methadone Research Web Guide, Retrieved from: https://www.drugabuse.gov/sites/default/files/pdf/partb.pdf
[10] Gowling L, Ali R, White J. Burprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2004;(4):CD002025.
[11] Johnson RE, Eissenberg T, Stitzer ML, Strain EC, Liebson IA, Bigelow GE. A placebo controlled clinical trial of buprenorphine as a treatment for opioid dependence. Drug Alcohol Depend. 1995;40:17–25.
[12] National Institute of Health, “Painkiller abuse treated by sustained buprenorphrine/naloxone” 2011. Retrieved from: https://www.nih.gov/news-events/news-releases/painkiller-abuse-treated-sustained-buprenorphine/naloxone
[13] Lancet (2011 Apr 30; 377(9776):1506-13
[14] US Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm198176.htm “FDA101: Smoking Cessation Products”
[15] Stead LF, et al. (2012). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (11).
[16] Wilkes, Scott, The use of bupropion SR in cigarette smoking cessation Int J Chron Obstruct Pulmon Dis. 2008 Mar; 3(1): 45–53. Published online 2008 Mar.
[17] Ebert, John, et al. (2010). Varenicline for smoking cessation: efficacy, safety, and treatment recommendations Patient Prefer Adherence. 2010; 4: 355–362. Published online 2010 Oct
[18] Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/treatment “Treatment: Medication”
