Medications for Alcohol Use

Disorder: Disulfiram, Naltrexone,

and Acamprosate

PREPARED BY QIRAT
YOUSUF
Introduction

• Briefly introduce the topic of the presentation, which

is the medications used in the treatment of alcohol
addiction.
• Explain the importance of these medications in
helping people overcome alcohol addiction.
Formula

1) Formula of Disulfiram:
The chemical formula of Disulfiram is C10H20N2S4. It is a white to off-white, odorless, and
almost tasteless powder that is soluble in water. The molecular weight of disulfiram is 296.54
g/mol.

2) Formula of Naltrexone:
The chemical formula of Naltrexone is C20H23NO4. It is a white to off-white, crystalline
powder that is insoluble in water and soluble in ethanol. The molecular weight of naltrexone is
341.4 g/mol.

3) Formula of Acamprosate:
The chemical formula of Acamprosate is C10H20N2O8S2. It is a white, odorless, and slightly
hygroscopic powder that is soluble in water. The molecular weight of acamprosate is 400.47
g/mol.
Brand names and class of Disulfiram
& its chemical structure

Disulfiram belongs to the class of drugs known as alcohol sensitizing agents.

The chemical structure of Disulfiram is as follows:

S S
|| ||
H3C - C - N-C-S-C-N - C - CH3
|| ||
S S
It contains a disulfide group (S-S) and a tertiary amine group (N(C2H5)2) in
its structure. The disulfide group is responsible for the drug's ability to
inhibit the enzyme acetaldehyde dehydrogenase, which is involved in the
breakdown of alcohol in the body.
Brand names and class of Acamprosate
& its chemical structure

Acamprosate belongs to the class of drugs known as

NMDA receptor antagonists and GABA analogs.
The chemical structure of Acamprosate is as follows:
H3C-CH2-SO3H
It contains a sulfonic acid group (SO3H) and an ethyl
group (CH2-CH3) in its structure. The mechanism of
action of Acamprosate is not fully understood, but it is
believed to act on the glutamate and GABA
neurotransmitter systems in the brain, which are
involved in alcohol dependence.
Brand names and class of naltrexone
& its chemical structure

• Naltrexone is available under several brand names, including

ReVia, Vivitrol, and Depade. It belongs to the class of
medications called opioid antagonists.
• Chemical structure: The chemical name of Naltrexone is 17-
(Cyclopropylmethyl)-4,5α-epoxy-3,14-dihydroxymorphinan-6-
one hydrochloride, and its molecular formula is
C20H23NO4•HCl. The chemical structure of Naltrexone is
derived from morphine and contains a cyclopropylmethyl group
attached to the nitrogen atom in the 17th position. It also
contains an epoxide ring in the 4,5 position and hydroxyl groups
in the 3 and 14 positions. The chemical structure of Naltrexone
is as follows:
chemical structure of Naltrexone

H3C
|
H3C--N--CH2--C(CH2OH)3
|
OH
|
O
|
CH2--C--CH
| |
CH2 OH

The molecule has a molecular weight of 377.86 g/mol and

appears as a white to off-white, crystalline powder.
1) Disulfiram
A. Indications
B. Contraindications
C. Mechanism
D. Side effects
Indications

• Disulfiram is indicated for the treatment of alcohol use

disorder (AUD). It is used to help individuals who have a
strong desire to stop drinking and need additional
support to maintain sobriety. Disulfiram is typically used
in combination with counseling and support programs
to help individuals develop coping strategies and
prevent relapse. The medication is not recommended
for individuals who are still actively drinking or who
have recently stopped drinking, as it can cause severe
reactions when combined with alcohol.
Contraindications

• Disulfiram is contraindicated in individuals who are

currently intoxicated with alcohol, have recently used
alcohol or drugs that can cause similar reactions, or
have a history of severe heart disease, psychosis, or
epilepsy. The medication should not be used in
individuals who are allergic to disulfiram or any of its
components. It should also be used with caution in
individuals who have a history of liver or kidney
disease, hypothyroidism, diabetes, or peripheral
neuropathy.
Mechanism

• Disulfiram works by inhibiting the enzyme aldehyde

dehydrogenase (ALDH), which is responsible for breaking
down acetaldehyde, a toxic byproduct of alcohol
metabolism. When alcohol is consumed while taking
disulfiram, acetaldehyde builds up in the bloodstream,
causing a range of unpleasant symptoms such as nausea,
vomiting, headache, flushing, and palpitations. These
symptoms are intended to discourage individuals from
drinking alcohol by creating a negative association
between drinking and unpleasant physical effects.
Side Effects:

• Disulfiram can cause a range of side effects, including

drowsiness, fatigue, headache, metallic or garlic-like taste in
the mouth, and skin rash. In rare cases, disulfiram can cause
more severe reactions such as liver damage, hepatitis, and
peripheral neuropathy. These severe reactions are more
likely to occur in individuals who are taking high doses of
disulfiram or who have pre-existing liver or kidney disease.
It is important to monitor liver function regularly while
taking disulfiram, as the medication can cause liver toxicity
in some individuals. If severe side effects occur, disulfiram
should be discontinued immediately.
2) Naltrexone
A. Indications
B. Contraindications
C. Mechanism
D. Side effects
Indications

• Naltrexone is indicated for the treatment of alcohol

use disorder (AUD) and opioid use disorder (OUD). It
works by blocking the effects of opioids and alcohol
in the brain, reducing cravings and preventing
relapse. Naltrexone is typically used in combination
with counseling and support programs to help
individuals develop coping strategies and maintain
sobriety. The medication is not recommended for
individuals who are still actively using opioids or
alcohol, as it can cause severe withdrawal symptoms.
Contraindications

• Naltrexone is contraindicated in individuals who are

currently using opioids, have recently used opioids,
or have a history of opioid dependence. The
medication should also be used with caution in
individuals who have liver or kidney disease, a
history of allergic reactions to naltrexone or any of its
components, or who are taking other medications
that affect the liver. Naltrexone is not recommended
for use during pregnancy, as it can cause fetal harm.
Mechanism

• Naltrexone works by blocking the effects of opioids

and alcohol in the brain. It binds to opioid receptors
in the brain, preventing opioids from producing their
usual effects of pain relief, euphoria, and sedation.
Similarly, naltrexone blocks the effects of alcohol,
reducing cravings and preventing relapse. Naltrexone
does not cause physical dependence or tolerance,
and it does not produce euphoria or sedation.
Side Effects:

• Naltrexone can cause a range of side effects, including

nausea, vomiting, diarrhea, abdominal pain, headache,
dizziness, fatigue, and insomnia. These side effects are
usually mild and resolve on their own within a few days of
starting treatment. In rare cases, naltrexone can cause
more severe side effects such as liver damage, hepatitis,
and allergic reactions. These severe side effects are more
likely to occur in individuals who are taking high doses of
naltrexone or who have pre-existing liver or kidney
disease. If severe side effects occur, naltrexone should be
discontinued immediately.
3) Acamprosate
A. Indications
B. Contraindications
C. Mechanism
D. Side effects
Indications

• Acamprosate is indicated for the maintenance of

abstinence in alcohol-dependent patients who have
recently ceased drinking. It is used as an adjunct to
psychosocial support as a treatment for alcohol
dependence in adults.
Contraindications

• Acamprosate is contraindicated in patients with

severe renal impairment or end-stage renal disease,
as well as individuals with a history of
hypersensitivity to acamprosate or any of its
components. It should also not be used in patients
with a creatinine clearance less than 30 mL/min.
Mechanism

• The exact mechanism of action of acamprosate is not

fully understood, but it is believed to work by
modulating the activity of certain neurotransmitters
in the brain. Specifically, acamprosate enhances
GABA transmission and blocks glutamate
transmission. This helps to reduce the unpleasant
symptoms associated with alcohol withdrawal and
craving.
Side Effects:

• Common side effects of acamprosate include

diarrhea, nausea, vomiting, headaches, dizziness,
and anxiety. These side effects are usually mild and
resolve on their own with continued use of the
medication. Less commonly, acamprosate may cause
suicidal ideation, severe depression, or allergic
reactions. If a patient experiences any of these
symptoms, they should seek immediate medical
attention. It is important to note that acamprosate
has a low risk of addiction or abuse.
Conclusion

• Disulfiram is a medication used in the treatment of

alcohol dependence. It is a unique medication that
works by producing an unpleasant reaction when
alcohol is consumed, making drinking alcohol
undesirable. This medication is effective in reducing
the risk of relapse in alcohol-dependent individuals
who have been detoxified. However, it has several
contraindications and potential side effects that
require careful monitoring during treatment.
Conclusion

• Disulfiram is a medication used in the treatment of

alcohol dependence. It is a unique medication that
works by producing an unpleasant reaction when
alcohol is consumed, making drinking alcohol
undesirable. This medication is effective in reducing
the risk of relapse in alcohol-dependent individuals
who have been detoxified. However, it has several
contraindications and potential side effects that
require careful monitoring during treatment.
Conclusion

• Acamprosate is a medication used in the treatment of alcohol

dependence. It works by modulating the activity of certain
neurotransmitters in the brain, helping to reduce the
unpleasant symptoms associated with alcohol withdrawal
and craving. It is generally well-tolerated and has a low risk of
addiction or abuse. However, it is contraindicated in patients
with severe renal impairment or end-stage renal disease, and
caution should be exercised in patients with a creatinine
clearance less than 30 mL/min. Overall, acamprosate is a
useful adjunct to psychosocial support in the maintenance of
abstinence in alcohol-dependent individuals.
• Disulfiram, Naltrexone, and Acamprosate are three drugs that
are commonly used in the treatment of alcohol use disorder.
Each of these drugs works in a different way to help individuals
reduce their alcohol consumption and maintain sobriety.
• Despite their effectiveness, it is important to note that these
drugs are not a cure for alcoholism, and they should only be
used as part of a comprehensive treatment plan that includes
therapy, support groups, and lifestyle changes.
• Overall, Disulfiram, Naltrexone, and Acamprosate offer hope for
those struggling with alcohol addiction and can greatly improve
the chances of achieving and maintaining long-term sobriety.
• Thank you for your attention and for taking the time
to learn about Disulfiram, Naltrexone, and
Acamprosate. I hope this presentation has been
informative and helpful in understanding the
indications, contraindications, mechanisms, and side
effects of these medications in the treatment of
alcohol use disorder. Remember, if you or someone
you know is struggling with alcohol addiction, there
is hope and help available.
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