This review with practical clinical focus offers an overview of available medication in Germany and current knowledge of treatment outcomes. Further, potential strategies of optimizing individual treatment of alcohol dependence are discussed.
Acamprosate, naltrexone and most recently nalmefene are approved in Germany for pharmacologic relapse prevention in alcohol dependent patients. In April 2011, disulfiram though being the most effective of the authorized substances lost its approval because the manufacturer no longer produces the drug due to “technological problems”. However, disulfiram still remains rather easily obtainable via international pharmacies.
Available evidence of relapse prevention for acamprosate if administered to a heterogeneous patient population is controversial. It has been suggested that only a specific group of patients might respond to acamprosate treatment. Its future therapeutic relevance will therefore depend on identifying this group of patients.
Current data for efficacy of naltrexone seem to be slightly more favorable showing some reduction on relapse probability to heavy drinking while effects on return to any drinking missed statistical significance in a recent meta-analysis. The opiate antagonist nalmefene is the first medication explicitly authorized for reduction of alcohol consumption and will shortly be introduced to the German market. The substance might embrace a wider patient population that has not yet been reached by abstinence oriented treatment strategies.
Finally, treatment options administered in off-label-use (like baclofen, topiramat) are briefly introduced as well as substances which are currently under development using novel pharmacological mechanisms of action.