New pharmacological approaches for the treatment of alcoholism

Abstract

Pharmacological relapse prevention in alcoholism is a rather new clinical field with few drugs being available. Acamprosate, acting predominantly via glutamatergic pathways, and the opioid receptor antagonist naltrexone, were both shown to be efficient in improving rates for continuous abstinence, and not relapsing to heavy drinking in a number of clinical trials and meta-analyses. There are conflicting data on both drugs, especially for acamprosate, according to some recent US studies. However, overall, the evidence is good. Both drugs are approved in most European countries and the US. Efficacy data for disulfiram are mixed; it is a second-line medication compared with other drugs, and is probably most effective when used in a supervised setting. Recently, anticonvulsants including carbamazepine and topiramate have been discussed as possible anti-craving drugs, but there is still limited evidence for their efficacy. Although there is a significant comorbidity for alcoholism with affective disorder, anxiety and schizophrenia, relatively few controlled clinical trials have been performed in this area. Tricyclics have been found to be more effective than serotonin reuptake inhibitors in improving depressive symptoms in these patients.

Acamprosate attenuates cocaine- and cue-induced reinstatement of cocaine-seeking behavior in rats

“…Acamprosate prolongs abstinence and reduces subjective measures of alcohol craving in alcoholic patients (see Heilig and Egli 2006;Rosenthal 2006;Soyka and Roesner 2006 for recent reviews). However, the potential efficacy of acamprosate in reducing the propensity to relapse to the use of abused drugs other than alcohol has received little attention.…”

Neurobiology, genetics and treatment of alcohol craving

“…Hem mevcut farmakolojik ajanların aşerme üzerine etkileri ölçülmekte hem de nörobiyoloji ve genetik alanından gelen bilgilerle geliştirilen yeni ajanların etkisi incelenmektedir (32).…”

Wichtige Ergänzung zur Rezidivprophylaxe und Trinkmengenreduktion

“…Es gibt allerdings Hinweise, dass Trizyklika bei Patienten mit Substanzabhängig-keit höhere antidepressive E ektivität aufweisen könnten als SSRI. Auch könn-ten stimmungsstabilisierende Substanzen wie Valproat zur Trinkmengenreduktion beitragen [23,24]. Eine alkoholspezische erapie kann aber dadurch nicht ersetzt werden.…”

“…Naltrexon: In Studien konnte belegt werden, dass der µ-Opioid-Antagonist Naltrexon sowohl Craving als auch Rückfallraten beziehungsweise Trinkmengen reduziert. Hinsichtlich der Verbesserung der Abstinenzraten scheint Naltrexon Acamprosat unterlegen zu sein; allerdings weist Naltrexon mögli-cherweise Vorteile bei der Reduktion der Trinkmenge auf [23,38,39]. In den USA ist Naltrexon als intramuskuläres Depotpräparat mit einer Wirksamkeitsdauer von 28 Tagen verfügbar.…”