Anti-craving pharmacotherapy (naltrexone, acamprosate, disulfiram)

Meet the patient

A 46-year-old man finishes a five-day inpatient detox on Friday. He is clear-headed, embarrassed, and asks a reasonable question: "Is there a tablet for the craving?"[5][9]

There is. There are three. And the difference between a good registrar and a great one is that the great one asks about his rib fractures before answering — because he is still on PRN oxycodone.[5][7]

Every one of these three drugs has exactly one gate that must be checked before the pen moves. Miss the gate and you precipitate withdrawal, accumulate a renally cleared drug, or hand an aversive agent to someone with no supervision.[5][6][8]

Examiners punish three failures here: mixing detox drugs with relapse-prevention drugs, vague dosing with no agent, dose, route, monitoring and contraindication, and cartoon readings of COMBINE.[1][5][9]

References16Show ledgerHide ledger

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