# Alcoholism (Alcohol Dependence) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Naltrexone hydrochloride 50 mg tablets US prescribing information, Clinical Trials - Alcoholism (DailyMed SetID adb7c4dc-221a-4d91-9687-0d78913a92ad, Chartwell RX): "These studies used a dose of naltrexone hydrochloride 50 mg once daily for 12 weeks as an adjunct to social and psychotherapeutic methods when given under conditions that enhanced patient compliance." · Alcohol Use Disorder: Screening, Evaluation, and Management (Nursing) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK568739/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS12.02 - condition scope only, no dose · Alcohol Use Disorder: Screening, Evaluation, and Management - StatPearls - NCBI Bookshelf - disease-level clinical article (alcoholism-full.txt) · Naltrexone - StatPearls (NBK534811), Alcohol Use Disorder section · MSF Essential Drugs 2024 - thiamine (vitamin B1), oral · Egyptian EML 2025, section 27.5.2 Medicines for alcohol use disorders (naltrexone, tablet 50 mg) · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - Naltrexone hydrochloride 50 mg tablets US prescribing information, Clinical Trials - Alcoholism (DailyMed SetID adb7c4dc-221a-4d91-9687-0d78913a92ad, Chartwell RX): "These studies used a dose of naltrexone hydrochloride 50 mg once daily for 12 weeks as an adjunct to social and psychotherapeutic methods when given under conditions that enhanced patient compliance." - Alcohol Use Disorder: Screening, Evaluation, and Management - StatPearls - NCBI Bookshelf - disease-level clinical article (alcoholism-full.txt) - Naltrexone - StatPearls (NBK534811), Alcohol Use Disorder section - MSF Essential Drugs 2024 - thiamine (vitamin B1), oral - Egyptian EML 2025, section 27.5.2 Medicines for alcohol use disorders (naltrexone, tablet 50 mg) - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - Naltrexone — 50 mg — oral.solid - No drug therapy in primary care (Referral & Advice) - Thiamine — 50 mg — oral.solid ## Complete treatment card ```text ALCOHOLISM (ALCOHOL DEPENDENCE) Sources: Naltrexone hydrochloride 50 mg tablets US prescribing information, Clinical Trials - Alcoholism (DailyMed SetID adb7c4dc-221a-4d91-9687-0d78913a92ad, Chartwell RX): "These studies used a dose of naltrexone hydrochloride 50 mg once daily for 12 weeks as an adjunct to social and psychotherapeutic methods when given under conditions that enhanced patient compliance." · Alcohol Use Disorder: Screening, Evaluation, and Management (Nursing) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK568739/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS12.02 - condition scope only, no dose · Alcohol Use Disorder: Screening, Evaluation, and Management - StatPearls - NCBI Bookshelf - disease-level clinical article (alcoholism-full.txt) · Naltrexone - StatPearls (NBK534811), Alcohol Use Disorder section · MSF Essential Drugs 2024 - thiamine (vitamin B1), oral · Egyptian EML 2025, section 27.5.2 Medicines for alcohol use disorders (naltrexone, tablet 50 mg) · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against 6 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Withdrawal features on stopping, plus needing steadily larger amounts to get the same effect - Thiamine deficiency can produce Korsakoff syndrome, with memory loss running both backwards and forwards [memory loss] - Existing psychiatric illness such as depression worsens; risk of stroke and dementia rises [low mood] - Obstructive sleep apnoea is aggravated, and the chance of developing it goes up [apnoea] SIGNS - what you find (4) - Alcohol-related hepatitis presents with jaundice, fever and ascites [ascites · fever · jaundice] - Alcohol-related cirrhosis can show palmar erythema, ascites and spider angiomas [ascites · cirrhosis · redness] - Unsteady walking points to thiamine deficiency striking the large nerve fibres - Small-fibre peripheral nerve damage in a stocking and glove pattern TESTS (10) - Screening uses the 1-item SASQ or the 3-item AUDIT-C consumption questionnaire - Severity by DSM-V count: 2 or more criteria is mild, 4 to 5 moderate, 6 or more severe - Blood alcohol level gauges acute intoxication - Serum ethyl glucuronide picks up drinking within the last 5 days - Carbohydrate-deficient transferrin reaches back roughly 2 weeks - Phosphatidylethanol stretches the detection window to about 3 weeks - False positives blunt the reliability of ethyl glucuronide and CDT - Liver enzymes may climb: ALT, AST and gamma-glutamyl transferase - Marrow suppression shows on the full blood count as low white cells, low platelets and anaemia - Large red cells, with or without anaemia, follow B12 and folate deficiency IF NOT THIS - what else fits (7) - Post-traumatic stress disorder - Bipolar disorder - Panic disorder - Anxiety disorder - Dysthymic disorder - Major depression - Insomnia Score CAGE questionnaire - Is this drinking a problem? Source StatPearls "Alcohol Use Disorder: Screening, Evaluation, and Management" - disease-level clinical article Status traced to the source above Rx: Relapse prevention | Main treatment | Vitamin replacement RELAPSE PREVENTION 1. NALTREXONE [1st line] Adult 50 mg once daily - Duration not stated in the source Peds No paediatric dose is given in the source; this is an adult regimen. Choice Naltrexone is the first choice here; it is the only anti-craving medicine for alcohol use disorder registered in Egypt. Source Naltrexone hydrochloride 50 mg tablets US prescribing information, Clinical Trials - Alcoholism (DailyMed SetID adb7c4dc-221a-4d91-9687-0d78913a92ad, Chartwell RX): "These studies used a dose of naltrexone hydrochloride 50 mg once daily for 12 weeks as an adjunct to social and psychotherapeutic methods when given under conditions that enhanced patient compliance." Why Named a first-line medicine for alcohol use disorder by the disease article, and listed on the Egyptian EML 2025 under 27.5.2 Medicines for alcohol use disorders as a 50 mg tablet. Six products are on the Egyptian register, so it can actually be dispensed. Caution RED FLAG - Do not give to anyone taking opioids. It is contraindicated in opioid dependence or current use of opioid analgesics including partial agonists, in acute opioid withdrawal, and after a failed naloxone challenge or a positive urine screen for opioids. The patient must be opioid-free, including tramadol, for at least 7 to 10 days before the first dose. In a patient with opioid use disorder it can precipitate withdrawal - dysphoria, irritability, tachycardia, tremor and sweating. Baseline and periodic liver function tests are necessary. Most prescribers hold off if liver function tests are 3 to 5 times above normal. Screen for depression and suicidal thinking during treatment. The source also names acamprosate and disulfiram for alcohol use disorder. Neither is on the Egyptian register nor on the Egyptian EML 2025, so neither can be dispensed in Egypt. Egypt MORFBLOCK 50 MG 10 F.C.TABS. COPAD EGYPT 180.00 EGP (18.00/unit) MORFBLOCK 50 MG 20 F.C.TABS. COPAD EGYPT 360.00 EGP (18.00/unit) ANARCOL 50 MG 30 F.C.TABS. MULTI-APEX 777.00 EGP (25.90/unit) MAIN TREATMENT 2. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Established dependence syndrome from chronic alcohol use. The source treats this as a condition primary care screens for and treats: it names naltrexone first-line and says pharmacotherapy should be offered, paired with behavioural therapy. Refer to an addiction service for structured withdrawal and for support beyond primary care, and screen for complications. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Established dependence syndrome from chronic alcohol use. The source treats this as a condition primary care screens for and treats: it names naltrexone first-line and says pharmacotherapy should be offered, paired with behavioural therapy. Refer to an addiction service for structured withdrawal and for support beyond primary care, and screen for complications. Caution Rare in Egyptian primary care. Screen every adult in primary care for unhealthy alcohol use, using a validated single- question or short screening tool. A patient with alcohol-related cirrhosis needs screening for hepatocellular carcinoma and, where appropriate, oesophageal varices. Vaccinate against hepatitis A and B if the patient with alcohol-related cirrhosis is not already immune. Vaccinate patients with alcohol use disorder against pneumococcal disease. Thiamine deficiency from chronic alcohol use can produce Korsakoff syndrome with both anterograde and retrograde amnesia. RED FLAG - Signs of withdrawal or delirium tremens (tremor, hallucinations, seizures, autonomic instability) are a medical emergency. Jaundice or abdominal swelling suggests alcoholic liver disease and needs referral. VITAMIN REPLACEMENT - give alongside 3. THIAMINE [add-on - not a substitute] Adult 10 to 25 mg once daily for mild chronic deficiency - Until recovery Peds The same source gives 10 mg once daily for infantile beriberi until complete recovery, over 3 to 4 weeks. Source MSF Essential Drugs 2024 - thiamine (vitamin B1), oral Why MSF names vitamin B1 deficiency, including alcoholic neuritis, as the indication, and records that B1 deficiency often occurs alongside other B-complex deficiencies, especially in patients who drink heavily. Caution For acute beriberi the same source gives 50 mg three times daily for a few days until symptoms improve, then 10 mg once daily until complete recovery. MSF gives thiamine for vitamin B1 deficiency and alcoholic neuritis. It does not state a regimen for preventing Wernicke's encephalopathy. In severe cases the source considers injectable thiamine justified to correct the deficiency quickly, but not once symptoms have improved. No contraindication or adverse effect is listed for oral thiamine, and none in pregnancy or breastfeeding. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)