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What other medications are prescribed for alcoholism?
Other medications are used off-label specifically for the treatment of alcoholism. One of the earliest thought to improve abstinence was lithium, although this has since proven to be false. Other studies investigating psychotropic medications have looked at the selective serotonin reuptake inhibitors (SSRIs), of which fluoxetine (Prozac) is the best known. The effects have been generally disappointing; however, when attempting to sort out alcoholics who are type I from those who are type II, there appears to be a noticeable though modest effect in type I alcoholics (see Question 18). This is thought to be because type I alcoholics more often suffer from anxiety and depression in addition to their alcoholism, and SSRIs are very effective antianxiety medications in addition to their antidepressant properties.
Two other medications have promise based on scientific evidence. These include Zofran, the trade name for ondansetron, and Topamax, the trade name for topiramate. Interestingly, just as SSRIs appear to improve abstinence rates in type I, or late-onset alcoholics, ondansetron appears to decrease preferentially the number of drinks consumed per day and improve abstinence rates in type II or early onset alcoholics.
Ondansetron blocks a specific serotonin receptor that is involved in nausea and vomiting and is commonly used in patients receiving cancer chemotherapy, where this is a common side effect. This particular serotonin receptor appears to play a role in reinforcement for alcohol consumption in animals. Blocking this receptor reduced alcohol consumption in animals. This was also demonstrated in early-onset or type II alcoholics, but was found to be no better than placebo when administered to late-onset or type I alcoholics. The preferential response to different medications based on one's subtype of alcoholism further supports a biological difference between these two types.
Topiramate is the other medication that appears to reduce craving and consumption in alcohol-dependent patients who are not yet abstinent. Topiramate is an anticonvulsant that is approved for use in the treatment of epilepsy. It was initially thought to also help with bipolar disorder, but studies have been disappointing. Topiramate can lead to decreased appetite and weight loss. The mechanism by which it reduces appetite is as yet unknown. Topiramate facilitates GABA function and antagonizes glutamate. In this manner, it appears to be similar to acamprosate. Its effects on GABA and glutamate, in turn, have an effect on dopamine and thus reduce craving and withdrawal feelings. Daily doses generally need to be 200 mg or greater. Initial studies have suggested that it has a greater effect on drinking than the currently FDA-approved medications, although it is also associated with more severe side effects. These side effects include slowing of thought, short-term memory problems, and word-finding difficulties. People were not required to be abstinent before initiation of topiramate for it to be effective.
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