| Maintenance of abstinence in alcohol use disorder in patients who are abstinent at treatment initiation (label). View labelExact | Label dosing is divided across the day (often three times daily) and is started after abstinence is achieved (label/guideline).
Dose reduction is recommended in moderate renal impairment and the medication is not recommended in severe renal impairment (label). | Glutamatergic/GABAergic modulator used to help maintain abstinence in alcohol use disorder after detoxification; best suited for people who are already alcohol-free and want support staying abstinent (label/guideline). | Not significantly metabolized (label) | Single-dose range 20–33 h | No | — | - Confirm abstinence at initiation and align expectations that acamprosate is a relapse-prevention support, not an acute withdrawal medication (label/guideline).
- Renal function: assess baseline kidney function and re-check if renal disease is present or if clinical status changes; dose-adjust per label (label/clinical).
- Monitor GI tolerability (diarrhea) and adherence, especially in the first weeks when drop-off is common (label/clinical).
- Monitor mood and suicidality as part of standard care for alcohol use disorder with co-occurring depression/anxiety (label/clinical).
| No | 2025-12-30 |
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| Treatment of alcohol dependence; blockade of the effects of exogenously administered opioids in the management of opioid dependence (label). View labelExact | Alcohol dependence: 50 mg once daily was used in placebo-controlled outpatient trials for up to 12 weeks as an adjunct to psychosocial methods (label). | Opioid receptor antagonist used for alcohol dependence and for opioid dependence relapse prevention via opioid blockade; requires an opioid-free period to avoid precipitated withdrawal and has hepatotoxicity cautions at higher doses. | Extensive hepatic metabolism (first pass) | Single-dose mean 4 h | No | — | - Liver function testing (baseline and follow-up), especially with alcohol-related liver disease (label/clinical).
- Opioid exposure screening and documentation of opioid-free verification strategy (label/clinical).
- Monitoring for nausea, dizziness, and fatigue that can affect adherence and function (clinical).
- Perioperative/acute pain planning because opioid analgesia may be ineffective while naltrexone is active (clinical).
| No | 2026-02-12 |
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| Adjunct in the management of chronic alcohol use disorder (aversion therapy) (label). View labelExact | Typically administered once daily; supervised dosing improves adherence and is associated with better outcomes in many settings (label/clinical).
Label guidance includes an alcohol-free interval before initiation and continued alcohol avoidance after stopping (label). | Aldehyde dehydrogenase inhibitor used as aversive therapy for alcohol use disorder; can cause a severe and prolonged reaction if alcohol is consumed (label/guideline). | Hepatic metabolism to diethyldithiocarbamate and other metabolites (label) | No | — | - Confirm alcohol abstinence at initiation and review “hidden alcohol” sources and emergency planning (label/clinical).
- Liver monitoring: baseline assessment and follow-up labs are commonly used, especially early in treatment or if symptoms of hepatitis appear (label/clinical).
- Track adherence and consider supervised dosing when feasible because missed doses reduce effectiveness (guideline/clinical).
- Review medication list for interactions at each visit and when new OTC products are started (label/clinical).
| No | 2025-12-30 |
|---|
topiramateAdjunctive therapyBrands: Topamax, Trokendi XR, Qudexy XR | Epilepsy; migraine prophylaxis (label). Common off-label use includes alcohol use disorder and weight mitigation (clinical). View labelExact | Psychiatric off-label use generally starts low (often 25 mg nightly) and increases in weekly steps to reduce cognitive and paresthesia burden (clinical). | Broad-mechanism antiepileptic and migraine-preventive agent (includes voltage-gated sodium-channel effects, enhanced GABA activity, AMPA/kainate antagonism, and carbonic anhydrase inhibition). In psychiatry it is sometimes used off label for alcohol use disorder, binge-eating disorder, and to mitigate antipsychotic-associated weight gain, balancing potential benefit against cognitive and metabolic adverse effects. | Not extensively metabolized; metabolites formed via hydroxylation, hydrolysis, and glucuronidation (label). | Single-dose mean 21 h | No | — | - Neurocognitive and functional monitoring (attention, word-finding, daytime function, driving safety) (label/clinical).
- Metabolic acidosis/kidney stone risk review; consider serum bicarbonate in higher-risk patients and counsel on hydration (label/clinical).
- Pregnancy-intent and contraception review, especially at higher doses or when oral contraceptives are used (label/clinical).
- Mood and suicidality monitoring when baseline risk is elevated (label/class).
| No | 2025-12-30 |
|---|