Brief Answer:
Topiramate has some anti-craving activity and dose can be hiked up.

Detailed Answer:
Hi XXXXXXX

Welcome to Healthcare Magic!

Treatment of alcohol dependence involves two stages:
1) Detoxification phase: In this, the patient is asked to stop alcohol immediately and medicines are given to manage the withdrawal from alcohol. It lasts for around 7 to 10 days.
2) Maintenance phase: This phase follows detoxification and the target is to keep the patient abstinent as long as possible and to manage lapses, if there are any. Anti-craving medicines or deterrent medicines are prescribed for this purpose.

Of the medicines your father is taking, haloperidol and trifluperazine (Neocalm) are antipsychotics which will help in controlling aggression, but will not have any effect on alcohol intake. Fluoxetine is an antidepressant with little anti-craving activity. Psychiatric illnesses like depression and psychosis may co-exist with alcohol dependence and should be treated. If such is the case with your father, then he would need a hike in the dosage of either the antipsychotics or the antidepressant, whichever is applicable.

Clonazepam is a benzodiazepine which will reduce anxiety and induce sleep. Topiramate (Topamax) has anti-craving activity but currently the dose is too low for any significant benefit.

A major factor in deciding the treatment plan is whether the patient wishes to quit alcohol or not. It appears from the medicines prescribed that your father is not willing and therefore, there has been no detoxification treatment. If this is true, then I would suggest that he be given a good anti-craving agent in a decent dose in the hope that as alcohol intake falls, he would be easier to motivate into quitting completely. For this, I would prefer baclofen over topiramate for two reasons. Topiramate would need to be given twice daily while XL preparations of baclofen can be given just once daily. Secondly, I have always found baclofen to be more effective and easier to tolerate than topiramate.

If and when your father agrees to quit alcohol, he should undergo detoxification phase preferably under admission/ under close medical supervision. Once he is abstinent, the option of disulfiram should also be considered. It is a deterrent medicine, which means that a person who is taking disulfiram, will not take alcohol because of the risk of serious reaction between the two.

In addition to all this, your father should take a thiamine (a B-complex vitamin) supplement as he is still drinking and alcohol depletes the thiamine levels in the body.

I hope this clears up things for you. Please feel free to ask in case you need any clarifications.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Must be started under medical supervision

Detailed Answer:
Hi,

Baclofen XL is usually started at 30 mg per day and gradually hiked up. Disulfiram can be started at 125 mg per day and hiked up as per requirement. It should NEVER be given without the patient's knowledge as disulfiram-alcohol reaction can sometimes be life threatening.These medicines must be started under medical supervision only and with an eye over the liver function.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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