• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Efficacy and Acceptability of Varenicline for Alcohol Use Disorder

Efficacy and Acceptability of Varenicline for Alcohol Use Disorder

August 6, 2020
Richard Moldawsky, MD
From The Carlat Addiction Treatment Report
Issue Links: Learning Objectives | Editorial Information
Richard Moldawsky, MD Dr. Moldawsky has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
REVIEW OF: Oon-Arom A et al, Drug Alcohol Depend 2019;205:1–9

Varenicline, a partial agonist of one of the nicotinic receptors, is approved for the treatment of tobacco use disorder and has also been found to decrease alcohol use in some individuals who smoke. Naltrexone, acamprosate, and disulfiram are FDA approved and effective for alcohol use disorder (AUD), but their use by prescribers has been limited, so identifying other options for the treatment of AUD remains important. Given the reciprocal influences of alcohol and tobacco use on one another, the authors investigated whether varenicline is effective and tolerable as a treatment for AUD.

The authors performed a meta-analysis of nine double-blind, randomized, placebo-controlled studies comparing varenicline with placebo, comprising 585 subjects with DSM-IV alcohol dependence or DSM-5 AUD. The dose in all studies was 2 mg/day. The studies ran from 4 to 13 weeks. Co-occurring psychosocial and behavioral treatments were allowed but not required. The main outcome measures were heavy drinking days and alcohol consumption. The secondary outcome measure was the dropout rate.

Varenicline was significantly better (p = 0.02) than placebo in decreasing total alcohol consumption. It was not superior in decreasing heavy drinking days. One 2018 study that had a low risk of bias—in which controlling and blinding were adequate—found that 29% of men prescribed varenicline had no heavy drinking days compared with 6% of men taking placebo; no difference was observed for women, however. Across all studies, the percentage of dropouts was nearly 50% for both the drug and the placebo groups, suggesting that long-term engagement in medical management of AUD may be challenging regardless of the medication used.

Comparing varenicline with other medications, the authors note that naltrexone reduces heavy drinking and craving, and acamprosate promotes abstinence but doesn’t affect alcohol consumption. Baclofen and topiramate also have been found to decrease alcohol consumption. The authors suggest that varenicline’s niche may be limited to decreasing alcohol consumption.

The authors acknowledge the small sample sizes and short durations of these trials, as well as the dearth of such studies in general. Most of the subjects smoked, a potentially significant confounder. These studies depended on the subjects’ self-reports. None of them tracked liver function tests, which may have revealed other adverse effects of varenicline and can serve as a marker of unreported alcohol use.

CATR’s TAKE
In this meta-analysis, varenicline demonstrated modest promise for AUD when the goal is decreased consumption, and may be useful for individuals with AUD who smoke. Whether its efficacy endures and whether it is a better choice than the FDA-approved medications for AUD are both important, unanswered questions.
Addiction Treatment
KEYWORDS alcohol alcohol-use-disorder pharmacology tobacco-use-disorder varenicline
Richard Moldawsky, MD

Is Ibogaine Safe for Opioid Detox?

More from this author
www.thecarlatreport.com
Issue Date: August 6, 2020
SUBSCRIBE NOW
Table Of Contents
CME Post-Test - Opioid Use Disorder Treatment, CATR, July/August 2020
Note From the Editor-in-Chief
“What About the Implant, Doc?” Appraising Various Formulations of Buprenorphine
Telemedicine for Addiction Treatment: Evidence and Implementation Strategies
Updated Guidelines for Treating Opioid Use Disorder
A Possible Option in Opioid-Related Harm Reduction
Efficacy and Acceptability of Varenicline for Alcohol Use Disorder
Featured Book
  • AUDFB1e_CoilBound_Graphic2_transparent_sm.png

    Treating Alcohol Use Disorder: A Fact Book (2023)

    All the tools and information needed to assess and treat your patients who are struggling with...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • Substance_Use_Sites.jpeg
    Addiction Treatment

    Supervised Drug Consumption Sites

    Once controversial, research clearly shows the benefit of these sites, and they have started opening in the United States.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.