title: Potential medications for the treatment of alcohol use disorder: An evaluation of clinical efficacy and safety.
abstract: Alcohol use disorder (AUD), as currently defined in the Diagnostic and Statistical Manual, 5th Edition (DSM-5), is a heterogeneous disorder stemming from a complex interaction of neurobiological, genetic, and environmental factors. As a result of this heterogeneity, there is no one treatment for AUD that will work for everyone. During the past 2 decades, efforts have been made to develop a menu of medications to give patients and clinicians more choices when seeking a therapy that is both effective and which has limited side effects. To date, 3 medications have been approved by the US Food and Drug Administration (FDA) to treat alcohol dependence: disulfiram, naltrexone, and acamprosate. In addition to these approved medications, researchers have identified new therapeutic targets and, as a result, a number of alternative medications are now being evaluated for treatment of AUD in human studies. Although not approved by the FDA for the treatment of AUD, in some cases, these alternative medications are being used off-label by clinicians for this purpose. These potential medications are reviewed here. They include nalmefene, varenicline, gabapentin, topiramate, zonisamide, baclofen, ondansetron, levetiracetam, quetiapine, aripiprazole, and serotonin reuptake inhibitors. The effectiveness of these medications has been mixed-some show good efficacy with side effects that are mild to moderate in intensity; others have mixed or promising results but are awaiting findings from ongoing studies; and still others show poor efficacy, despite promising preliminary results. Medications development remains a high priority. Key initiatives for the National Institute on Alcohol Abuse and Alcoholism (NIAAA) include supporting the discovery and development of more effective and safer medications, advancing the field of personalized medicine, and forging public and private partnerships to investigate new and more effective compounds.
authors.affiliation: a NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism , Bethesda , Maryland , USA.
authors.forename: Raye Z
authors.initials: RZ
authors.lastname: Litten
authors.affiliation: b Coalition on Physician Education in Substance Use Disorders (COPE) , Easton , Maryland , USA.
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Wilford
authors.affiliation: a NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism , Bethesda , Maryland , USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Falk
authors.affiliation: a NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism , Bethesda , Maryland , USA.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Ryan
authors.affiliation: a NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism , Bethesda , Maryland , USA.
authors.forename: Joanne B
authors.initials: JB
authors.lastname: Fertig
mesh_terms: D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000627:therapeutic use; D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D004221:Disulfiram / Q000627:therapeutic use*; D006801:Humans; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D056687:Off-Label Use; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D011619:Psychotropic Drugs; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram
keywords: Alcohol use disorder (AUD); medications development; novel medications; personalized medicine; pharmacotherapy