Use of acamprosate and opioid antagonists in the treatment of alcohol dependence: A European perspective

In thirteen of sixteen placebo-controlled trials in Europe, acamprosate increased abstinence in detoxified alcohol-dependent patients. It is approved in most EU countries. Its action at N-methyl-D-aspartate (NMDA) receptors appears to account for many of its effects. The number needed to treat in the fifteen trials suitable for meta-analysis has been calculated at 8.15. Trials of naltrexone in Europe have shown less clear evidence of efficacy than trials of acamprosate, whether abstinence or relapse to heavy drinking is used as the outcome criterion. With reduction in heavy drinking days as the criterion, naltrexone compared favorably to acamprosate in an open study in moderate alcohol dependence; one double-blind study has pointed to an advantage of the combination of naltrexone with acamprosate over either drug. To date, there are no trials published of nalmefene in European clinics. While many centers routinely offer a trial of acamprosate to newly detoxified patients aiming for abstinence, naltrexone usage varies. Some centers suggest naltrexone not only for patients aiming for abstinence but also for patients for whom continued drinking is a therapeutic possibility or a clinical inevitability.