Brand
Name/Dose |
Generic
Name |
What It Is |
What It Does |
How It Works |
Advantages |
Disadvantages |
Monthly
Cost |
Campral
333 mg t.i.d. |
acamprosate |
homotaurine: the amino acid taurine modified to be absorbed from GI tract and cross the blood-brain barrier |
Reduces alcohol relapses by reducing response to triggers |
Restores chemical balance in brain by inhibiting glutamate overactivity |
No reaction if patient drinks alcohol.
Not processed by liver.
Effect persists after stopping meds. |
Many pills (6/day).
Diarrhea occasionally, usually transient.
Effect is modest.
Caution if kidney disease. |
$177 |
Revia
50 mg/day |
naltrexone |
Long acting, oral opioid antagonist |
Reduces alcohol and opioid relapses by reducing cravings and blocking euphoric effect of alcohol and opioids |
Blocks effect of opioids released by alcohol
Best for patients with strong family history of alcohol dependence |
No reaction if patient drinks alcohol |
Nausea.
Blocks opioids necessary for medical and surgical treatment.
Possible endorphin blockade.
Effect is modest.
No carryover effect. |
$167 |
Vivitrol
IM once monthly |
naltrexone |
Intramuscular naltrexone |
Reduces alcohol and opioid relapses |
Blocks effect of opioids released by alcohol |
Once monthly administration reduces compliance problems |
Same as Revia x 30 days.
Requires IM buttocks injection.
Cost? |
$700 |
Topamax
100 - 300 mg/day |
topiramate |
Anticonvulsant |
Reduces alcohol relapses |
Facilitates GABA and antagonizes glutamate receptors |
Causes weight loss |
Can reduce cognitive functioning ("Dopamax").
Few studies. |
$241
(200 mg) |
Suboxone
Subutex
(bup only)
4 - 24 mg/day |
buprenorphine
+
naloxone |
Partial mu agonist + short acting parenteral opioid antagonist |
Reduces opioid relapses |
Blocks effect of opioids |
Low overdose danger.
Low abuse danger except IV.
Blocks use of other opioids.
Used in traditional medical setting. |
Patient is not abstinent.
Discontinuation can cause troublesome withdrawal symptoms.
Not approved for use in pregnancy.
|
$395
(16 mg) |
Accomplia
not yet approved |
rimonabant |
Central and peripheral cannabanoid (CB1) antagonist |
Doubles the odds of quitting smoking without causing weight gain |
Antagonizes endocannabinoids released by nicotine |
Potential marijuana blocker.
Possible use for nicotine addiction. |
FDA: "approvable" for weight loss but not for smoking cessation |
Not available |
| Chantix |
varenicline |
Nicotinic acetylcholine receptor agonist |
Facilitates smoking cessation by reducing desire for and effect of cigarettes |
Activates nicotine receptors and blocks the effect of nicotine |
No reaction if patient smokes |
Nausea, insomnia
Caution if renal impairment
|
$110 |
