Pharmacogenomics of alcohol addiction: Personalizing pharmacologic treatment of alcohol dependence

Abstract

SUMMARYAlcohol dependence is a serious psychiatric disorder with harmful physical, mental and social consequences, and a high probability of a chronic relapsing course. The fi eld of pharmacologic treatment of alcohol dependence and craving is expanding rapidly; the drugs that have been found to reduce relapse rates or drinking in alcohol-dependent patients and are approved for treatment of alcohol dependence are naltrexone, acamprosate and disulfi ram, whereas also topiramate appears as a promising therapy. For many patients, however, these treatments are not eff ective. Evidence from a number of diff erent studies suggests that genetic variation is a signifi cant contributor to interindividual variation of clinical presentation of alcohol problems and response to a given treatment. The aim of the present review is to summarize and discuss the fi ndings on the association between gene polymorphisms and the response to alcohol dependence treatment medications. It is anticipated that future implementation of pharmacogenomics in clinical practice will help personalize alcohol dependence drug treatment, and development personalized hospital pharmacology.

Gene-gene interaction of μ-opioid receptor and GluR5 kainate receptor subunit is associated with smoking behavior in a Greek population: presence of a dose allele effect

“…A multisystem activity in nicotine dependence and the complexity of the reward pathways should further be elucidated. Interaction of OPRM1 A118G polymorphism with other polymorphic genes, such as delta and kappa opioid receptors and dopamine transporter, has also been reported in studies assessing the reinforcing properties of alcohol [26]. Therefore, the interplay of genetic variants of different systems towards a dependence phenotype merits further investigation.…”

“…OPRM1 A118G polymorphism is among the most described polymorphisms in pharmacogenomic studies regarding alcohol dependence treatment with naltrexone and opioid drugs [23,25,26]. Regarding smoking behavior, it has been differentially associated with various aspects of smoking behavior, with wild-type 118A allele increasing risk to nicotine dependence and favoring smoking cessation and 118G allele increasing risk for smoking initiation [27].…”

Flumazenil in treatment benzodiazepine withdrawal syndrome: Case report

“…Benzodiazepine dose is reduced or benzodiazepine is introduced with longer eff ect of equivalent dose or other drugs are introduced (primarily psychostabilizers -lamotrigine, carbamazepine, valproate) administered upon discontinuation of benzodiazepine. Long-term substitution treatment in people at high doses of benzodiazepines and the structural changes of personality [7] is less commonly implemented. Th e main drawback of this approach is the very length of detoxifi cation, which can range from 2-3 weeks to several months, which greatly aff ects the efficiency and comfort of the procedure.…”

From Homer and Hippocrates to Modern Personalized Medicine: Is There a Role for Pharmacoepigenomics in the Treatment of Alcohol Addiction?

“…Treatment methods for alcoholism combine medications, behavioral treatment and peer support to retain abstinence and prevent long-term relapse. A pharmacological adjunct to psychosocial therapy is necessary in most of the cases, since without pharmacotherapy the clinical outcome is poor, with up to 70% of patients resuming drinking within 1 year [6,7].…”

“…Options for alcohol addiction pharmacotherapy are limited and several other compounds have been tested for alcohol dependence treatment, some of them currently being at various stages of clinical development. Interestingly, a series of compounds, clinically approved for indications other than alcohol addiction, appear to have the ability to reduce alcohol consumption [6,7]. The most recent example is an anti-inflammatory drug, ibudilast, primarily used in asthma, that appears to reduce cravings and stress-related symptoms [8].…”