Anti-craving agents for alcohol dependence are all except aEUR'
Lorazepam Management of alcohol intoxicationDrugs used areLorazepam (can worsen the vitals because of C.N.S. depression)Haloperidol (can lower the seizure threshold)Other drugs which may be usedZiprasidoneOlanzapineManagement of alcohol withdrawlAll patients should be given oral multiple vitamin B1including 50-100 mg of thiamine daily for a week.Replace alcohol (CNS depressant) with any other C.N.S. depressant. Benzodiazepenes are commonly used for this purpose and chlordiazepoxide is the drug of choice because of its long half life.Delirium Tremens :?Some recommend, high dose Benzodiazepene while others recommend antipsychotics.Anticonvulsants are not given to control seizures seen in delirium Tremens.Management of alcoholic rehabilitationMainstay of alcoholic rehabilitation involves counselling, education and cognitive approaches. Several medications have also proved beneficial :-Naltrexone (opioid antagonist) ?It blocks opioid receptors and thus decrease the activity in dopamine rich ventral tegrnental reward system or decrease the feeling of pleasure or reward if alcohol is imbibed.Acamprosate ?Widely used in United States and Europe. The drug inhibits the action of NMDA receptors and has been hypothesized to act by decreasing mild symptoms of protracted withdrawl.Disulfiram (ALDH inhibitor)Drinking alcohol, while taking disulfiram, produces a reaction involving an increased pulse, changes in blood pressure, vomiting and diarrhoea. This can be dangerous especially for patients with hea disease, stroke, diabetes mellitus or hypeension.Thus most clinicians reserve this medication for patients who have a clear history of longer term abstinence associated with prior use of disulfiram and for those who might take the drug under the supervision of another individual.Other drugs under investigation for possible use in Alcoholics- Ondansetron (serotonin antagonist)- Topiramate (anticonvulsant)- Ratnonthant (cannabinoid receptor antagonist)
Lorazepam
Acamprosate
Topiramate
Naltrexone