Consumption of alcohol has increased during the COVID-19 pandemic. The Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) defines alcohol use disorder (AUD; previously called alcohol dependence) as meeting ≥2 of the 11 criteria listed in Table 1 in the past year. The lifetime prevalence of AUD in the US population has been estimated to be about 30%. Despite this high prevalence and the associated morbidity, mortality, and costs, only 3 drugs are FDA-approved for treatment of the disorder.

Acamprosate calcium (Campral - Forest) is now being marketed for oral use to maintain abstinence from alcohol. It has been used in France and other countries since 1989.

An injectable extended-release formulation of the opioid-receptor antagonist naltrexone (Vivitrol - Alkermes/Cephalon) has been approved by the FDA for once-monthly use, along with psychosocial support, to maintain abstinence from alcohol. Naltrexone inhibits the rewarding effects of alcohol. Oral naltrexone (Revia, and others) has been approved for treatment of alcohol dependence since 1994, but poor adherence has limited its effectiveness. In the new extended-release (XR) formulation, naltrexone is encapsulated in polylactide-co-glycolide microspheres (similar to absorbable suture material)...

Terfenadine (Seldane - Marion Merrell Dow) and astemizole (Hismanal - Janssen) are nonsedating antihistamines widely used to treat symptoms of allergic rhinitis (Medical Letter, 27:65, 1985; 31:43, 1989). Both are available without a prescription in Canada, and the US Food and Drug Administration is apparently considering terfenadine for over-the-counter availability in the USA.

Naltrexone (ReVia -DuPont Pharma), a long-acting oral opioid antagonist previously marketed for treatment of opioid dependence under the trade name Trexan, was recently approved by the US Food and Drug Administration (FDA) for treatment of alcohol dependence. The new trade name will now also be used for the old indication.

A 0.75% vaginal gel formulation of metronidazole (MetroGel-Vaginal - Curatek) and a 2% vaginal cream formulation of clindamycin phosphate (Cleocin - Upjohn) were recently approved by the US Food and Drug Administration for treatment of bacterial vaginosis. Seven days' treatment with oral metronidazole, 500 mg b.i.d., has been the usual treatment for this condition, with oral clindamycin, 300 mg b.i.d., as an alternative (JL Thomason et al, Am J Obstet Gynecol, 165:1210, 1991).

View the Inhibitors and Inducers of CYP Enzymes, P-Glycoprotein, and Other Transporters tables

A topical formulation of 0.75% metronidazole gel (MetroGel - Curatek), an antibacterial, antiparasitic agent, was recently approved by the US Food and Drug Administration for treatment of rosacea.

Cefmetazole sodium (Zefazone - Upjohn), a second-generation parenteral cephalosporin, was recently marketed in the USA for intravenous (IV) treatment of various infections caused by susceptible organisms. Like cefotetan (Cefotan), cefamandole (Mandol), cefoperazone (Cefobid), and moxalactam (Moxam), cefmetazole contains a methylthiotetrazole group that has been associated with prothrombin deficiency.

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

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