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Am Fam Physician. 2006;74(11):1836

to the editor: The article, “Medications for Treating Alcohol Dependence,” in the November 1, 2005, issue of American Family Physician is a useful, comprehensive review of the pharmacotherapeutic options available for treating alcohol-dependent patients.1 Family physicians often are the first to diagnose alcohol dependence, and manage ongoing treatment of patients initially diagnosed by subspecialists. This article illustrates that alcohol dependence can be treated effectively using pharmacotherapy when combined with psychosocial interventions.1 However, I would like to add several clarifications and corrections.

The dosage of acamprosate (Campral) is incorrectly stated throughout the article and in Table 1 as being weight-based.1 The correct dosing regimen for acamprosate is two 333-mg enteric-coated tablets taken three times daily to achieve the full 1,998-mg per day dosage recommended by the U.S. Food and Drug Administration (FDA). Acamprosate at this dosage should be initiated after alcohol withdrawal (no gradual titration is necessary) and should be maintained in patients who relapse.

For disulfiram (Antabuse), Table 1 recommends a starting dosage of 250 mg per day and then increasing to 500 mg per day.1 Some patients do require higher doses of disulfiram to ensure the alcohol/disulfiram reaction; however, most patients do well with 250 mg per day. Maintaining the 250 mg per day dosage may lead to fewer toxicities and adverse events.

In the article,1 the data given for nalmefene (Revex) come from one of the two initial single-site randomized controlled trials (RCTs) that indicated therapeutic benefit for nalmefene.2 However, a more recent, larger, multisite RCT did not find evidence of efficacy for nalmefene.3

The reported data on ondansetron (Zofran) are accurate1 but are based on one study,4 as other RCTs in adults have yet to be conducted. Furthermore, the dosage of ondansetron given in Table 1 is not readily available to physicians.1

It is also important for physicians to be aware that a once-monthly injectable formulation of naltrexone (Vivitrol) was recently approved by the FDA for alcohol dependence.

The development of new pharmacologic agents with proven efficacy for alcohol dependence—acamprosate, naltrexone (ReVia), and long-acting naltrexone—is an important advance. Hopefully, family physicians will gain confidence in the use of these new pharmacotherapies to expand the treatment of alcohol dependence.

editor’s note: This letter was sent to the authors of “Medications for Treating Alcohol Dependence,” who declined to reply.

Email letter submissions to Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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