View Full Version : Straight talk about the Craving Meds

July 30th, 2006, 05:40 PM
This is from the ...:cool:


Alcoholism? Topirimate (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#top) ? Nefazodone (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#nef) ? Ondansetron (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#ond) ? Naltrexone (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#nal) ? Disulfiram (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#dis) ? Campral (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#cam)TOPIRIMATE (topomax) shows promise in treating alcoholism. This anti- convulsant, mood stabilizing medication can help reduce the alcohol cravings of alcohol abusers, making it easier to withdraw from alcohol. The researchers of a recent significant study published in The Lancet on the use of topirimate for alcohol abuse postulated that it reduces alcohol cravings by reducing brain levels of the neurotransmitter dopamine (which is believed to create the pleasurable sensations alcoholics get from drinking). The topirimate seems to reduce the cravings and anxiety associated with withdrawal, and potentially resets the brain's chemistry. Topirimate has also been found to be helpful in treating binge eating disorder. The following online article provides more information about the above four medications.

Research Study: Johnson BA, Ait-Daoud N, Bowden CL, et al. "Oral topirimate for treatment of alcohol dependence: a randomized trial. The Lancet. 361:1677-1685, 2003. (http://www.addictionrecoveryguide.org/shared/pdf-small.gif download pdf (http://www.ukmicentral.nhs.uk/therapeu/di_desp/MedDesp2003v106.pdf))

NEFAZODONE (Serzone) is an antidepressant which has been found in one study to cause significant reduction in alcohol cravings, drinks/week and days of alcohol used. Serzone has been associated with some severe liver problems which have led Bristol Myers Squib Canada to withdraw it from the market in Canada. Anyone using it in the United States or elsewhere should have their physician closely monitor their liver function tests.
http://www.addictionrecoveryguide.org/shared/totop.gif top (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#top)
ONDANSETRON (Zofran) which is used to treat the nausea and vomiting caused by certain chemotherapies has been found to stop cravings and decrease alcohol consumption and increase abstinence in people who are early-onset alcoholics. FDA approval for Ondansetron for early-onset alcoholism treatment is currently being considered.
NALTREXONE can help lessen alcohol's positive effects. It blocks the parts of your brain that "feel" pleasure when you use alcohol and narcotics. When these areas of the brain are blocked, you feel less need to drink alcohol, and can stop drinking more easily.
Naltrexone has been shown to improve treatment outcomes in alcoholics when combined with psychosocial treatments such as Alcoholics Anonymous meetings, addiction counseling, family therapy, group therapy, and hospital or residential treatment, among others. However, adherence to daily oral doses has often been a problem, making its use in the treatment of alcohol dependence limited. While nausea is the most common side effect, other side effects include headache, anxiety, dizziness, fatigue, vomiting and insomnia.
The recent development of long-acting naltrexone injections may help with this problem of inconsistent use of the medication. In a recent clinical study conducted at 24 sites, once-a-month Naltrexone injections combined with psychotherapy was found to significantly reduce heavy drinking in patients being treated for alcohol dependency. Results found a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six-month treatment period. There were few side effects.

Garbutt, J, et al. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial." JAMA. 293(13): 1617-1625, 2005.
http://www.addictionrecoveryguide.org/shared/totop.gif top (http://www.addictionrecoveryguide.org/medications/alcoholism/index.html#top)
DISULFIRAM (Antabuse) disrupts alcohol metabolism leading to a buildup of acetaldehyde that causes flushing, nausea and vomiting, weakness and lowered blood pressure, among many other effects. Increased depression and worsening of psychosis have been noted. In some cases the reaction may be fatal. Disulfiram begins to effect alcohol metabolism within 1-2 hours and reaches a peak in 12 hours. It is slowly excreted from the body in the next 2 weeks. People who cannot commit to avoiding alcohol should not use this medication.
CAMPRAL (genereic name: acamprosate), a drug that is widely used in Europe to reduce alcohol cravings in problem drinkers who have quit, has now been approved by the U.S. Food and Drug Administration. The FDA approved Campral after studies showed that more subjects who were given the drug stayed away from alcohol, compared with those who were given a placebo. However, they cautioned that Campral might not be effective for people who are currently drinking when they start taking the drug, or for those who are misusing other substances. The drug will be available in the U.S. by the end of 2004.

Campral reduces alcohol relapse by reducing the bad feelings that result when a person abstains. It works by stimulating GABA, an amino acid that acts as a neurotransmitter, transferring chemical messages between neurons in the brain. GABA can also be taken as part of amino acid therapy. (For more information on amino acid therapy see the chart on amino acids (http://www.addictionrecoveryguide.org/holistic/nutrition.html#amino) under Nutrition (http://www.addictionrecoveryguide.org/holistic/nutrition.html) in the Holistic (http://www.addictionrecoveryguide.org/holistic/index.html) section of this web site).
The following online article provides more information about the above four medications:
Richard A. Rawson, PhD, Michael J. McCann, M.A., Albert L. Hasson, MSW ?Pharmacotherapies for Substance-Abuse Treatment.? Counselor Magazine. October, 2000.
counselormagazine.com (http://www.counselormagazine.com/display_article.asp?aid=Pharmacotherapies_for_Subs tance_Abuse_Treatment.asp)

July 31st, 2006, 09:22 AM
Interesting stuff, here, CV. My only slight quibble with the info would be with the info about the nefazadone (Serzone). I have been on Serzone for quite a few years now, and darn it! I WISH it had reduced my cravings!!! Makes me wonder a little about the "placebo effect" though, because had I been told at the time that serzone would reduce my cravings, maybe I would have thought it would have!! At any rate, serzone is one of the antidepressants that works on norepinephrine, rather than serotonin, so it is interesting to see it in the mix of possible anti-craving drugs.

July 31st, 2006, 11:37 AM
Kathy, absolutely agree. I wonder if you are taking Tyrosine or DL-Phenylalanine to compensate for the norepinephrine might help with cravings? One reason I've never gone on meds for the ssri is that they don't really cure the problem, which is low levels of one or the other, they just keep the low levels active which really can deplete them more. I guess that's why I'm more drawn to the holistic/nutrition side of things to repair the damage I do with regards to lousy diet, exercise, stress and alcohol. I'll do some more checking also, but be aware that pharm companies love to make "light" of the side effects and really emphasize the "positive" effects that perhaps only a slight majority of folks experienced and reported.:cool:

August 3rd, 2006, 11:27 AM
CV, Thank you so much for your wealth of information! I am new and going to see my doctor today. I was going to try this program without the topa because I was afraid to ask for it. But armed with the knowledge I have gleaned from the links you've provided and the lancet article, I think I will ask for the topa.

August 4th, 2006, 07:24 AM
:h Go for it. Just feel your way through this and take things a bit at a time. Good luck with the doctor.