Pharmacotherapy for alcohol dependence: status of current treatments

- Alcoholism is a progressive disorder involving several neurotransmitter systems.
- Currently, there are only 3 approved medications.
- Nalmefene is pending for approval for use on an as-needed basis.
- Combination pharamacotherapy could enhance treatment alcohol use outcomes.
- Medication development in AUD is increasingly focusing on targeting psychiatric and somatic comorbidity.

The efficacy of medications for alcohol dependence remains modest, and there are no strong clinical predictors of treatment response. Approved medications include acamprosate (an N-methyl-d-aspartate receptor (NMDA) modulator), disulfiram (an acetaldehyde dehydrogenase inhibitor) and naltrexone (an opioid antagonist) while nalmefene (an opioid antagonist) is currently under review for approval in Europe. Clinical trials suggest that baclofen (a GABA-B agonist) and topiramate (an anticonvulsant) may be promising candidates, while several other drug candidates are currently evaluated at early clinical stages.