Relapse Prevention in Alcoholics: A Review of Acamprosate versus Naltrexone

OBJECTIVE: To compare two anticraving drugs, acamprosate and naltrexone, for effectiveness, kinetics and tolerability in patients with abusing or dependent on alcohol. DESIGN: This study reviewed all published double-blind, placebo-controlled trials of patients abusing or dependent on alcohol. Main clinical outcome measures were: time to relapse, cumulative relapse rate, total number of drinks during study period. SETTING: Mainly ambulant cases. PATIENTS: Patients consisted of 3338 acamprosate and more than 200 naltrexone cases. INTERVENTIONS: Some studies also used psychosocial support, one combined acamprosate with disulfiram. RESULTS: Both drugs were superior to placebo. Drop-out rates were comparable between drugs. Naltrexone caused more adverse effects than acamprosate. Acamprosate has been studied for over 1 year and has been shown to remain effective with carry-over of the effect after stopping the medication for at least 1 year; naltrexone has been studied for 3 months, with no carry-over. CONCLUSION: Both drugs were effective, but acamprosate may be preferred above naltrexone because of its proven long-term effectiveness with carry-over.