Alcohol use disorder - Revision history

Rossdonaldson1: /* See Also */

2023-11-08T19:28:29Z

Rossdonaldson1: /* Background */

2023-11-08T19:27:50Z

Background

← Revisión anterior		Revisión del 19:27 8 nov 2023
Línea 1:		Línea 1:
	==Background==		==Background==
	[[File:Number with an alcohol use disorder, OWID.svg\|thumb\|]]		[[File:Number with an alcohol use disorder, OWID.svg\|thumb\|Epidemiology of alcohol use disorder.]]
	* Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.		* Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.
	* Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.		* Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.

Rossdonaldson1: /* Background */

2023-11-08T18:57:14Z

Background

← Revisión anterior		Revisión del 18:57 8 nov 2023
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Number with an alcohol use disorder, OWID.svg\|thumb\|]]
	* Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.		* Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.
	* Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.		* Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.
	* It is estimated that about 6% of adults in the US suffer from alcohol use disorder.		* It is estimated that about 6% of adults in the US suffer from alcohol use disorder.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Gabapentin */

2023-11-08T18:38:50Z

Gabapentin

← Revisión anterior		Revisión del 18:38 8 nov 2023
Línea 66:		Línea 66:
	'''Evidence'''		'''Evidence'''
	*A metanalysis of several randomized control trials demonstrates that use of gabapentin for alcohol use disorder reduces the number of total heavy drinking days. <ref>Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547-1555.</ref>		*A metanalysis of several randomized control trials demonstrates that use of gabapentin for alcohol use disorder reduces the number of total heavy drinking days. <ref>Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547-1555.</ref>
	*~~Furthermore, the addition~~ of [[gabapentin]] to [[naltrexone]] further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>		*Addition of [[gabapentin]] to [[naltrexone]] further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>

	====[[Disulfiram effect\|Dilsulfiram]]====		====[[Disulfiram effect\|Dilsulfiram]]====

Rossdonaldson1: /* Management */

2023-11-08T18:38:13Z

Management

← Revisión anterior		Revisión del 18:38 8 nov 2023
Línea 51:		Línea 51:
	'''Evidence'''		'''Evidence'''
	*A Cochrane review assessed the efficacy of naltrexone in randomized control trials.<ref>Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews. 2005;(1). </ref>		*A Cochrane review assessed the efficacy of naltrexone in randomized control trials.<ref>Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews. 2005;(1). </ref>
	**~~Naltrexone helps~~ to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).		**Helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).
	*~~Naltrexone reduces~~ the time in days to first drink when compared to placebo or disulfiram.		*Reduces the time in days to first drink when compared to placebo or disulfiram.
	*~~Naltrexone reduces~~ reported cravings and the total amount of alcohol consumed.		*Reduces reported cravings and the total amount of alcohol consumed.
	*~~Naltrexone should~~ be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.		*Should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.

	====[[Gabapentin]]====		====[[Gabapentin]]====
Línea 62:		Línea 62:
	**Renally dosed if CrCl<60		**Renally dosed if CrCl<60
	**ACOG approves of use in pregnancy		**ACOG approves of use in pregnancy


	'''Evidence'''		'''Evidence'''
Línea 67:		Línea 68:
	*Furthermore, the addition of [[gabapentin]] to [[naltrexone]] further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>		*Furthermore, the addition of [[gabapentin]] to [[naltrexone]] further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>

	=== [[Disulfiram effect\|Dilsulfiram]] ===		====[[Disulfiram effect\|Dilsulfiram]]====
	*~~Disulfiram can~~ be prescribed as alcohol avoidance therapy. This can be prescribed in the emergency department or referred to PCP/psychiatrist treating the patient's addiction.		*Can be prescribed as alcohol avoidance therapy. This can be prescribed in the emergency department or referred to PCP/psychiatrist treating the patient's addiction.

	==Disposition==		==Disposition==

Rossdonaldson1: /* Gabapentin */

2023-11-08T18:37:14Z

Gabapentin

← Revisión anterior		Revisión del 18:37 8 nov 2023
Línea 56:		Línea 56:
	*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.		*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.

	===[[Gabapentin]]===		====[[Gabapentin]]====
	~~====~~Evidence~~:====~~		'''Dosage'''
			*[[Gabapentin]] 600 mg PO TID #90 tabs, no refills
			**Counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week
			**Renally dosed if CrCl<60
			**ACOG approves of use in pregnancy

			'''Evidence'''
	*A metanalysis of several randomized control trials demonstrates that use of gabapentin for alcohol use disorder reduces the number of total heavy drinking days. <ref>Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547-1555.</ref>		*A metanalysis of several randomized control trials demonstrates that use of gabapentin for alcohol use disorder reduces the number of total heavy drinking days. <ref>Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547-1555.</ref>
	*Furthermore, the addition of gabapentin to naltrexone further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>		*Furthermore, the addition of [[gabapentin]] to [[naltrexone]] further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>

	~~====Dosage====~~
	*Gabapentin 600 mg PO TID #90 tabs, no refills
	**counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week
	**renally dosed if CrCl<60
	**ACOG approves of use in pregnancy

	=== [[Disulfiram effect\|Dilsulfiram]] ===		=== [[Disulfiram effect\|Dilsulfiram]] ===

Rossdonaldson1: /* Naltrexone */

2023-11-08T18:35:48Z

Naltrexone

← Revisión anterior		Revisión del 18:35 8 nov 2023
Línea 44:		Línea 44:
	***Must be off short-acting opioids for 1 week and methadone for 2 weeks		***Must be off short-acting opioids for 1 week and methadone for 2 weeks
	**Planned surgery/anesthesia in next 30 days (okay to use tablets, stop 1 day prior to surgery)		**Planned surgery/anesthesia in next 30 days (okay to use tablets, stop 1 day prior to surgery)
	**[[Acute liver injury]] with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)		**Acute liver injury with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)
	**[[Pregnancy]]		**[[Pregnancy]]
	**[[Allergy]]		**Allergy

Rossdonaldson1: /* Naltrexone */

2023-11-08T18:35:10Z

Naltrexone

← Revisión anterior		Revisión del 18:35 8 nov 2023
Línea 39:		Línea 39:
	====[[Naltrexone]]====		====[[Naltrexone]]====
	'''Dosage'''		'''Dosage'''
	*Naltrexone 380 mg IM or ~~Naltrexone~~ 50 mg PO qday #30 tabs, no refills		*[[Naltrexone]] 380 mg IM or 50 mg PO qday #30 tabs, no refills
	Contraindications ~~for use in AUD~~:		*Contraindications:
	*Any opioid use (including Buprenorphine):		**Any opioid use (including [[Buprenorphine]]):
	**Must be off short-acting opioids for 1 week and methadone for 2 weeks		***Must be off short-acting opioids for 1 week and methadone for 2 weeks
	*Planned surgery/anesthesia in next 30 days (okay to use tablets, stop 1 day prior to surgery)		**Planned surgery/anesthesia in next 30 days (okay to use tablets, stop 1 day prior to surgery)
	*Acute liver injury with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)		**[[Acute liver injury]] with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)
	*Pregnancy		**[[Pregnancy]]
	*Allergy		**[[Allergy]]


Línea 55:		Línea 55:
	*Naltrexone reduces reported cravings and the total amount of alcohol consumed.		*Naltrexone reduces reported cravings and the total amount of alcohol consumed.
	*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.		*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.


	===[[Gabapentin]]===		===[[Gabapentin]]===

Rossdonaldson1: /* Management */

2023-11-08T18:33:56Z

Management

← Revisión anterior		Revisión del 18:33 8 nov 2023
Línea 36:		Línea 36:
	{{Vitamin prophylaxis for ETOH}}		{{Vitamin prophylaxis for ETOH}}

	===Medication Assisted Treatment ~~for Alcohol Use Disorder~~===		===Medication Assisted Treatment===
	===[[Naltrexone]]~~===~~		====[[Naltrexone]]====
	~~====Evidence:~~====		'''Dosage'''
	*A Cochrane review assessed the efficacy of naltrexone in randomized control trials.<ref>Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews. 2005;(1). </ref>
	**Naltrexone helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).
	*Naltrexone reduces the time in days to first drink when compared to placebo or disulfiram.
	*Naltrexone reduces reported cravings and the total amount of alcohol consumed.
	*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.

	~~====~~Dosage~~:====~~
	*Naltrexone 380 mg IM or Naltrexone 50 mg PO qday #30 tabs, no refills		*Naltrexone 380 mg IM or Naltrexone 50 mg PO qday #30 tabs, no refills
	Contraindications for use in AUD:		Contraindications for use in AUD:
Línea 54:		Línea 47:
	*Pregnancy		*Pregnancy
	*Allergy		*Allergy


			'''Evidence'''
			*A Cochrane review assessed the efficacy of naltrexone in randomized control trials.<ref>Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews. 2005;(1). </ref>
			**Naltrexone helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).
			*Naltrexone reduces the time in days to first drink when compared to placebo or disulfiram.
			*Naltrexone reduces reported cravings and the total amount of alcohol consumed.
			*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.


	===[[Gabapentin]]===		===[[Gabapentin]]===

Rossdonaldson1: /* Management */

2023-11-08T18:32:23Z

Management

← Revisión anterior		Revisión del 19:28 8 nov 2023
Línea 77:		Línea 77:

	==See Also==		==See Also==
			*[[Ethanol toxicity]]

	==External Links==		==External Links==

← Revisión anterior		Revisión del 18:32 8 nov 2023
Línea 39:		Línea 39:
	===[[Naltrexone]]===		===[[Naltrexone]]===
	====Evidence:====		====Evidence:====
	**A Cochrane review assessed the efficacy of naltrexone in randomized control trials.<ref>Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews. 2005;(1). </ref>		*A Cochrane review assessed the efficacy of naltrexone in randomized control trials.<ref>Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews. 2005;(1). </ref>
	**Naltrexone helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).		**Naltrexone helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).
	**Naltrexone reduces the time in days to first drink when compared to placebo or disulfiram.		*Naltrexone reduces the time in days to first drink when compared to placebo or disulfiram.
	**Naltrexone reduces reported cravings and the total amount of alcohol consumed.		*Naltrexone reduces reported cravings and the total amount of alcohol consumed.
	**Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.		*Naltrexone should be offered to patients with alcohol use disorder who are interested in reducing alcohol intake.

	====Dosage:====		====Dosage:====
	**Naltrexone 380 mg IM or Naltrexone 50 mg PO qday #30 tabs, no refills		*Naltrexone 380 mg IM or Naltrexone 50 mg PO qday #30 tabs, no refills
	Contraindications for use in AUD:		Contraindications for use in AUD:
	**Any opioid use (including Buprenorphine):		*Any opioid use (including Buprenorphine):
	***Must be off short-acting opioids for 1 week and methadone for 2 weeks		**Must be off short-acting opioids for 1 week and methadone for 2 weeks
	**Planned surgery/anesthesia in next 30 days (okay to use tablets, stop 1 day prior to surgery)		*Planned surgery/anesthesia in next 30 days (okay to use tablets, stop 1 day prior to surgery)
	**Acute liver injury with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)		*Acute liver injury with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)
	**Pregnancy		*Pregnancy
	**Allergy		*Allergy

	===[[Gabapentin]]===		===[[Gabapentin]]===
	====Evidence:====		====Evidence:====
	**A metanalysis of several randomized control trials demonstrates that use of gabapentin for alcohol use disorder reduces the number of total heavy drinking days. <ref>Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547-1555.</ref>		*A metanalysis of several randomized control trials demonstrates that use of gabapentin for alcohol use disorder reduces the number of total heavy drinking days. <ref>Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547-1555.</ref>
	**Furthermore, the addition of gabapentin to naltrexone further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>		*Furthermore, the addition of gabapentin to naltrexone further helped to reduce cravings in the first 6 weeks of AUD. <ref>Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31. PMID: 21454917; PMCID: PMC3204582.</ref>

	====Dosage====		====Dosage====
	**Gabapentin 600 mg PO TID #90 tabs, no refills		*Gabapentin 600 mg PO TID #90 tabs, no refills
	***counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week		**counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week
	***renally dosed if CrCl<60		**renally dosed if CrCl<60
	***ACOG approves of use in pregnancy		**ACOG approves of use in pregnancy

	=== [[Disulfiram effect\|Dilsulfiram]] ===		=== [[Disulfiram effect\|Dilsulfiram]] ===