There are several medications that can be used to help patients who struggle with Alcohol Use Disorders, such as alcohol abuse and alcohol dependence. We are able to provide these treatments for alcohol use disorders in-office in Philadelphia, Manhattan and Wilmington, DE AND virtually to the various states that we serve, including Pennsylvania, New Jersey, New York, Delaware, Maryland, Florida, California and the USVI.
Oral Naltrexone: This is a medication that is frequently used to reduce cravings for alcohol. It was first developed in 1963, and first approved as a treatment for addiction in 1984. This medication works by antagonizing (blocking) the opiate receptors in the brain (and it was first approved as a treatment for patients with opiate dependence). With that said, patients will state that it substantially reduces cravings for alcohol as well, which is likely because the opiate receptors that it blocks, are involved in the “reward pathway” of the brain. This pathway affects cravings for various substances, such as alcohol. Although this medication has been utilized for alcohol abuse and dependence for decades, unfortunately many patients do not realize that it is a readily available option for the treatment of alcohol use disorders. The medication is typically taken once daily (usually 50 mg) and it generally provides protection from alcohol cravings throughout the day. In the US it’s typically taken daily, but in Europe it is often prescribed “as needed.” Our offices will discuss the risks and benefits of not only this medication (it is generally well tolerated), and also the pros and cons of taking it daily vs. on an “as needed basis.”
Vivitrol (Injectable Naltrexone): Vivitrol is a newer branded medication that is a long acting injection of Naltrexone (described above). The injection is typically given every 4 weeks, and provides patients with protection from cravings for alcohol throughout this 4 week period. Some patients prefer knowing that they have protection from cravings for approximately a month, as opposed to needing to take a medication daily. Patients will sometimes state, “having to do the right thing and take a medication once a month, can be a lot easier than doing the right thing every day.” Patients will also often describe that Vivitrol injections seem much more effective at curbing cravings for alcohol, than a typical oral naltrexone pill. Dr. Pagnani works with a network of pharmacies throughout Pennsylvania in particular, who are able to administer this injection monthly to his patients, with his oversight as the prescriber.
Antabuse (Disulfiram): It is our opinion, that Antabuse (Disulfiram) is a very underutilized medication in psychiatry for alcohol use disorders. Antabuse works by blocking an enzyme that breaks down a metabolite of alcohol (it inhibits aldehyde dehydrogenase). When an individual takes Antabuse, if they drink they can become incredibly ill, which serves as a significant deterrent from alcohol use – for many, making it a complete non-issue, because they frankly cannot drink if they are taking this mediation. If an individual does drink with this in their system, they can become violently ill, which psychologically can change the association that the patient has between alcohol use and a pleasurable feeling. Of note, some individuals have such severe reaction to drinking if they take this medication, that it can be dangerous for their health. Patients must understand that they are committing to abstinence, if they take this medication. Of specialists in Philadelphia, Manhattan, Delaware and Virtually will review risks and benefits of Antabuse for alcohol use disorder treatment.
Campral (Acamprosate): Acamprosate can be used to decrease cravings for alcohol in individuals who suffer from Alcohol Use Disorders. It works differently than Naltrexone and Vivitrol, and for some, can be a very helpful medication. When individuals drink frequently, or are dependent on alcohol, their bodies may start to make less GABA (your major inhibitory or “calming” neurotransmitter). This is because alcohol is a “depressant,” so the body starts to think that it doesn’t need to make as much of its natural “depressant” (or calming) neurotransmitter. In fact, when an individual is dependent on alcohol, their body may start to make more glutamate (the neurotransmitter that “excites” your nerves), to make up for the depressant effects of alcohol. “Excited nerves” can cause people to feel more anxious, tremulous, and have cravings when they try to stop drinking. Campral is thought to work by re-calibrating GABA and Glutamate, when individuals stop drinking alcohol. Our offices in Philadelphia, Manhattan, Delaware and virtually, can discuss Campral as an option for alcohol use disorder treatment.
This list is by no means exhaustive, and there are several other medications used in the treatment of Alcohol Use Disorders in Philadelphia, Manhattan, Delaware and the areas that we serve.
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