Alcohol And Seniors

 

Antabuse and  Naltrexone

Antabuse (Disulfiram)

What It Is

Antabuse is a drug that produces unpleasant effects when the person drinks alcohol while taking the drug. It is less effective than naltrexone and may cause hypotension (low blood pressure) in older persons, especially people who have underlying heart disease. (1)

 

Adverse effects

Antabuse is not recommended for use in older patients because of the increased risk of serious adverse effects. (2, 3, 4)


 

Naltrexone

What It Is

Naltrexone (Trexan, ReVia) is an opiate antagonist that reduces cravings for alcohol. (1) Naltrexone is intended to be used  as an addition to psychosocial support to reduce the risk of relapse. (5). It has been approved as an adjunct to psychosocial treatment  (e.g., counselling, support groups) and should not be seen as a replacement of psychosocial interventions. (5)

In the United States, naltrexone is approved by the Food and Drug Administration (FDA) for use with people who have been diagnosed as alcohol dependent, are medically stable, and are not currently (or recently) using opioids (e.g., controlled pain medication) (5)    Its role in the treatment of older people who drinking problems has not been well established.   However, according to the Merck's Manual of Geriatrics: "It can reduce relapse rates by 50% when combined with psychosocial intervention. The usual dose of 50 mg/day is well tolerated by most elderly patients." [ but see notes on actual research with older adults  below].

 

How It Works:

Naltrexone blocks the pleasurable and painkilling effects of opioid drugs.  For people who want to quit drinking, taking naltrexone daily will reduce the urge to drink. According to Alberta Alcohol and Drug Abuse Commission ( 6), if people take a drink while on this drug, they will find that they enjoy drinking less, and so they are less likely to keep drinking.

 

Who It Works Best For:

People participating in most naltrexone studies are in their early forties, on average.  (5)

Naltrexone is used as an addition to psychosocial support. As a result, it is recommended that people be assessed for their willingness to work with a health care provider or be involved in support group in order to help them have the best outcomes.

Some studies (not senior specific) suggest people who have high levels of craving, poor cognitive abilities, little education, or high levels of physical and emotional distress may derive particular benefit from the addition of naltrexone therapy to their psychosocial treatment.

 

Adverse effects:  

The only study of  naltrexone conducted with older adults listed in the ETOH database  is by Oslin et al, 1997 (7). In that study, the adverse effects in older adults included nausea, vomiting, headache, low energy, joint pain, and anxiety.  However, the authors go on to conclude: "The results of this study indicate that naltrexone was well tolerated and efficacious in preventing relapse among this group of older alcoholic patients." The study involved veterans aged 50  to 70, and  only about 20 were on the drug, the others given a placebo.

Health care providers are generally urged to use caution when administering naltrexone to people with impaired kidney/ liver function. They are also urged to regularly test the person's liver function before and during naltrexone treatment. Abnormalities in liver function tests have been reported in people who are obese and older persons who have taken naltrexone, even where they had no history of drug abuse.

 

Cost Issues: Naltrexone is usually prescribed for three months, if the person benefits from its use. (6) The  cost of naltrexone can be a barrier.  In British Columbia in 1997, for example,  the cost for 50 mg of Naltrexone was $5.70 a day  (one tablet) or over $500 for a 3 month period; in Yukon the formulary cost for  50 mg was 5.00 a tablet or $450  (8, 9)  Costs in other provinces will vary. Additional costs to consider include followup liver function tests (5).  Cost issues are an important consideration for people of all ages.

 

Does it Last?  What happens when people stop taking the drug?  With naltrexone, people seem to have more control over their use of alcohol in the short run.  (10)  If people finish taking the full course of the drug and start drinking again, they tend to not rebound to the same level of drinking they were at before.  Instead, they may gradually start drinking again, but with more overall days of abstinence and fewer drinks per drinking day than people who were not on the drug... However, even then the drug’s effects may not last longer than 14 weeks, which is why it is generally advised to have ongoing psychosocial treatment during and after use of the drug...

More Information Needed: The National Institute on Alcohol Abuse and Alcoholism notes the need for more research on naltrexone in older adults (along with several other needed groups) (5)

 


 

 References

 (1) Merck Manual of Geriatrics (Online at: www.merck.com/pubs/mm_geriatrics/sec4/ch37.htm)

(2) Alcoholism in the elderly. Council on Scientific Affairs, American Medical Association. JAMA 1996; 275:797-801.

(3) Dufour M & Fuller RK. Alcohol in the elderly. Annu Rev Med 1995;46:123-32.

(4) Schonfeld L,&  Dupree LW. Treatment approaches for older problem drinkers. Int J Addict 1995;30:1819-42.

(5) TIPS 28, Naltrexone And Alcoholism Treatment. Online at: http://hstat.nlm.nih.gov/hq/Hquest/fws/T/db/local.tip.tip28/screen/Browse/s/59266/action/GetText/linek/28

 www.health.org/govpubs/BKD268/28g.aspx

(6)   AADAC Fact Sheets, Naltextrone http://corp.aadac.com/drugs/factsheets/Naltrexone.asp

(7)   Oslin D., Liberto J.G., O'Brien J. et al. (Fall, 1997) Am J Geriatr Psychiatry, 5(4):324-32

(8)  Therapeutics Inititiave  www.ti.ubc.ca/pages/letter17.htm#Naltrexone%20(Revia®)

 (9) Yukon Drug Program Formulary ( November , 2002) http://www.hss.gov.yk.ca/docs/dformulary.pdf

(10)   Psychiatry Drug Alerts (March, 2001) No. 3.  Naltrexone plus CBT Follow-up Study,  http://alertpubs.com/Issues/2001/Sda32001.PDF

 

Also See:

Naltrexone, Summary Sheet, June 2001  http://www.keele.ac.uk/depts/mm/MTRAC/ProductInfo/summaries/N/NALTREXONEs.html

 

Page last updated: Sunday October 31, 2004

Prepared by: Charmaine Spencer,  Gerontology Research  Centre, Simon Fraser University, Vancouver, BC (c) 2003

 

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