Clinical Efficacy of the 5‐HT₃ Antagonist Ondansetron in Alcohol Abuse and Dependence

Abstract

Medications that act on the serotonergic system have been found to be of benefit in the treatment of alcohol-dependent individuals. In a randomized, placebo-controlled study, the efficacy of 6 weeks of ondansetron, a 5-HT3 antagonist (0.25 mg bid or 2.0 mg bid), in the treatment of 71 nonseverely alcohol-dependent males was tested. The results showed reduction of drinking differences were steadily increasing toward the end of the treatment period approached significance at week 7 in the 0.25 mg group (p = 0.06). Twice as many patients in this group showed > or = 2 standard deviations decrease in drinking compared with the other groups. When patients drinking > 10 drinks/drinking day at baseline (n = 11) were excluded from the analysis, significant group differences were found at both treatment and follow-up, with the lower ondansetron dose producing the greatest reduction from baseline (i.e., 2.8 standard drinks; -35% compared with baseline and -21% compared with placebo; p < 0.02-0.001). Within this group, there was an almost 4-fold greater number of patients showing a clinically meaningful decrease in drinking. Lower baseline drinking and higher level of education were significant and strong predictors of drinking reduction during treatment. Ondansetron was very well tolerated; hence, further long-term studies with 5-HT3 antagonists alone or in combination with other treatment components may offer promise for treatment of alcoholism.

Acamprosate and Prevention of Relapse in Alcoholics

“…The results are contradictory, and the significance of the find ings is difficult to evaluate on account of the selectivity of the populations studied [4], This also largely applies to the SSRIs and the serotonin agonists. In early studies in excessive drinkers, SSRIs appeared to be more effective than placebo [5], but in later studies with a longer follow up and in 'heavier' drinkers and alcoholics these results could not be confirmed [6,7], A recent development is the use of the opioid antagonist naltrexone in the prevention of relapse in alcoholics. The results of the first studies are promising [8] and have drawn renewed attention to the importance of combined pharmacotherapeutic and psy chosocial intervention [9], The latter study showed that naltrexone reduced the number of drinking days and the time to first relapse during 12 weeks of treatment.…”

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings

“…First, in a 6-week, double-blind, placebo-controlled study of 71 non-severely alcoholdependent males, Sellers et al [232] observed that the 0.5-mg dose but not the 4-mg dose of ondansetron was associated with a non-significant trend (p = 0.06) toward a reduction in alcohol consumption. Post-hoc analysis that eliminated 11 subjects who consumed less than 10 drinks/ drinking day rendered the difference in drinking outcomes between the ondansetron 0.5 mg and placebo groups to be significant statistically (p = 0.001).…”

A Within‐Group Design of Nontreatment Seeking 5‐HTTLPR Genotyped Alcohol‐Dependent Subjects Receiving Ondansetron and Sertraline

“…Another serotonergic medication, ondansetron, has been found to be more effective for a univariate subtype of alcohol-dependent individuals Sellers et al, 1992Sellers et al, , 1994. More specifically, ondansetron appears to be more effective for the EOA, but not the LOA subgroup.…”