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Naltrexone
(Depade, ReVia)
- Action: Blocks opioid receptors, reducing craving and drinking response
- Contraindication: opioid use, acute opioid withdrawal, acute hepatitis, liver failure
- Adverse Reaction: precipitate severe withdrawal if opioid dependent; hepatotoxicity
- Interaction: opioid
- *Monitor liver function
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Extended-Release Injectable Naltrexone
(Vivitrol)
- Action: same (block opioid receptors, reducing cravings and response)
- C: Same (opioid); inadequate muscle mass for deep injection; rash/infection at inj site
- Ad Reaction: same (withdrawal for opioid); infection; depression; rare events (allergic pneumonia, suicidal ideation)
- Drug Interaction: opioids
- *Monitor liver function
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Acamprosate
(Campral)
- Action: glutamate & GABA neurotransmitter systems
- C:
renal impairment- Ad Reaction:
suicidal ideation and behavior- Interaction:
none*Renal Function
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Disulfiram
(Antabuse)
- Action:Inhibits alcohol metabolism, causing acetaldehyde buildup and reaction of flushing, sweating, nausea, and tachycardia if alcohol is consumed
- C:
alcohol or metronidazole use; CAD; severe myocardial disease; hypersensitivity to rubber (thiuram) derivatives- Ad Reaction:
Disulfiram-alcohol reaction; hepatotoxicity; optic neuritis, peripheral neuropathy, psychotic reactions- Drug Interaction:
*warfarin; any nonprescription drug containing alcohol*; isoniazid; metronidazole; phenytoin*First evaluate liver function, then monitor
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