Review: acamprosate and naltrexone are safe and effective but have low compliance rates for people with alcohol dependence.

Are acamprosate and naltrexone safe and effective treatments for adults with alcohol dependence?METHODSDesign: Systematic review with meta-analysis.Data sources: CINAHL, EMBASE, MEDLINE, and the Cochrane Controlled Trials Register (January 1990 to September 2002) plus hand searches of reference lists.Study selection and analysis: Eligible studies were randomised controlled trials comparing naltrexone or acamprosate with placebo or a control group not taking any medication. Exclusions: <10 people in the study; less than 2 weeks' follow up; lack of relevant primary clinical data; or no quantitative results. Data were extracted on study scope and design, randomisation process, sample size, intervention, exclusion and inclusion criteria, baseline characteristics, length of treatment and follow up, outcome, and treatment compliance. A random effects model was used to carry out meta-analysis. Peto's odds ratios were used to measure dichotomous outcomes and weighted mean differences were used to measure continuous outcomes.Outcomes: Relapse and abstinence rates; treatment compliance and duration of abstinence.MAIN RESULTSThirty three studies met inclusion criteria. Thirteen studies compared acamprosate with placebo, 19 studies compared naltrexone with a control group (placebo or reference group), and one study compared naltrexone with acamprosate. Acamprosate significantly improved abstinence rate and treatment compliance compared with placebo (see http://www.ebmentalhealth.com/supplemental for table). Acamprosate significantly increased the duration of abstinence compared with placebo (weighted mean difference: 27 days; SD 18-36.5 days). Acamprosatc produced few side effects. The most common adverse events were gastrointestinal problems. In the short term, naltrexone significantly reduced relapse rate but not abstinence rate compared with controls (see table). Few studies reported the effects of long term naltrexone use. Naltrexone caused frequent side effects, however these did not significantly lower adherence to treatment.CONCLUSIONSNaltrexonc and acamprosate are both safe and effective treatments for alcohol dependence in adults. Acamprosate improves adherence and abstinence rates, whereas naltrexone significantly reduces relapse rates, time to relapse, and frequency of drinking. However, the high level of non-compliance for both treatments may limit their usefulness.NOTESAll studies involved some form of psychosocial intervention in combination with naltrexone or acamprosate that varied widely between studies. [ABSTRACT FROM AUTHOR]