Injectable medications for alcohol use disorder
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Injectable Medications for Alcohol Use Disorder: Key Options and Effectiveness
Extended-Release Injectable Naltrexone for Alcohol Use Disorder
Extended-release injectable naltrexone is a leading FDA-approved injectable medication for alcohol use disorder (AUD). Research consistently shows that this medication helps reduce the number of drinking days, delays the time to first drink or heavy drinking day, and increases abstinence rates, especially when combined with psychosocial therapy. However, complete abstinence is achieved by less than half of patients, even with this treatment Kedia2022Kranzler2018Fairbanks2020+3 MORE.
Comparison with Oral Medications and Adherence
Injectable naltrexone offers some advantages over oral medications. Studies show that adherence rates are higher with extended-release injectable naltrexone compared to oral naltrexone, disulfiram, or acamprosate. For example, one study found that 24.4% of patients achieved high adherence (80% or more of days covered) with injectable naltrexone, compared to 22.7% for oral naltrexone and lower rates for other medications . Better adherence is important because it can lead to improved treatment outcomes Walker2019Malhotra2023.
Effectiveness in Hospital and Special Populations
Both oral and injectable naltrexone, when started in the hospital, lead to significant reductions in heavy drinking days. However, there is no significant difference in effectiveness between the two forms in reducing heavy drinking or health care utilization at three months. The choice between oral and injectable naltrexone should be based on patient preference, insurance, and other practical factors .
For special populations, such as people experiencing homelessness or those with poor medication adherence, extended-release injectable naltrexone is recommended to improve adherence and outcomes. However, naltrexone is not suitable for patients using opioids, as it can cause withdrawal .
Other Injectable Medications
Currently, extended-release injectable naltrexone is the primary FDA-approved injectable medication for AUD. Injectable antipsychotics like risperidone have been studied in patients with co-occurring schizophrenia and AUD, but they are not approved for AUD treatment and show only modest benefits in reducing drinking days compared to oral forms .
Underutilization and Clinical Guidelines
Despite strong evidence and clinical guidelines recommending naltrexone (oral and injectable) as first-line treatments for moderate to severe AUD, these medications are underprescribed. Less than 9% of patients who could benefit from medication receive it, and overall use in large health systems remains low Kranzler2018Fairbanks2020Kranzler2023+1 MORE.
Conclusion
Extended-release injectable naltrexone is an effective and well-studied option for treating alcohol use disorder, especially for patients who struggle with adherence to daily oral medications. It reduces drinking and increases abstinence, but complete abstinence is uncommon. The choice between oral and injectable forms should be individualized. Despite their benefits, injectable medications for AUD remain underused, highlighting the need for greater awareness and access in clinical practice.
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