Suppression of Craving for γ-Hydroxybutyric Acid by Naltrexone Administration

Caputo, Fabio; Vignoli, Teo; Lorenzini, Francesca; Ciuffoli, Elena; Re, Arfedele Del; Stefanini, Giuseppe Francesco; Addolorato, Giovanni; Trevisani, Franco; Bernardi, Mauro

doi:10.1097/01.wnf.0000159954.49393.76

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…The data emerging from our case series are very similar to previous experiences with SMO and NTX (Caputo et al, 2005, 2007). Indeed, the association of NMF with SMO induces complete abstinence from alcohol (two cases), suppresses (five cases) or reduces (two patients) episodes of HDDs, and suppresses craving for SMO (one patient).…”

Section: Discussionsupporting

confidence: 87%

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Sodium oxybate plus nalmefene for the treatment of alcohol use disorder: A case series

et al. 2016

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The treatment of alcohol use disorder still remains a challenge. The efficacy of the combined pharmacological treatment for alcohol use disorder has been widely investigated with controversial results. The aim of our case series was to investigate the effect of nalmefene in patients not responding to sodium oxybate therapy. We describe seven cases of consecutive patients affected by alcohol use disorder, and treated with sodium oxybate (50 mg/kg per day) who did not achieve complete alcohol abstinence after at least one month of pharmacological treatment. Then, in partial- and non-responder patients to sodium oxybate treatment, administration of nalmefene, 18 mg as needed, was commenced. Our data show that, during the first month of the combined treatment of sodium oxybate plus nalmefene, patients were able to achieve alcohol abstinence (two patients), to suppress (five cases) or reduce (two patients) episodes of heavy drinking days, and to suppress the onset of craving for sodium oxybate (one patient). Likely, nalmefene may act in modulating the excessive reward effect of sodium oxybate, which may be responsible for the persistence of alcohol intake and for the onset of craving for sodium oxybate. However, controlled clinical trials to confirm the safety and efficacy of sodium oxybate plus nalmefene in treating alcohol use disorder are warranted.

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Section: Discussionsupporting

confidence: 87%

“…However, episodes of HDDs occurred. In order to induce complete abstinence, and suppress craving for SMO (Caputo et al, 2005), NMF (18 mg as needed) was added. He felt the need to take NMF every day without reporting any side effects.…”

Section: Case Seriesmentioning

confidence: 99%

Sodium oxybate plus nalmefene for the treatment of alcohol use disorder: A case series

et al. 2016

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“…On the contrary, 10% of those subjects treated with GHB alone developed craving for GHB [67]. This observation is consistent with a previous observation by Caputo et al [68] and may indicate that the anti-reward properties of naltrexone may be able to avoid the development of craving for GHB (Figure 1).…”

Section: Ghb Compared and Combined With Other Medications In The Treasupporting

confidence: 91%

The therapeutic potential of gamma-hydroxybutyric acid for alcohol dependence: balancing the risks and benefits. A focus on clinical data

Addolorato¹,

Leggio

Ferrulli³

et al. 2009

Expert Opinion on Investigational Drugs

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There is an increasing interest in studying the role of GABAergic medications in the treatment of alcohol dependence. The GABAergic drug gammahydroxybutyric acid (GHB) has been investigated in Europe as a possible treatment for alcohol dependence. In some European Countries, GHB has been approved as a treatment for alcohol dependence. However, this drug has also shown addictive properties, therefore raising questions about its safety in treating alcohol-dependent subjects. More recent research is focusing on the possibility of identifying alcohol-dependent subtypes without risk of developing GHB abuse. Finally, GHB and naltrexone combined together represent a possible approach deserving future investigations.

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“…The reaction of the experts as well as of the public authorities is always preferably too cautious. The good Italian experiences with GHB (Addolorato et al, 1996, 1998, 2000; Poldrugo and Addolorato, 1999; Maremmani et al, 2001; Caputo et al, 2003, 2005; Nava et al, 2006; Maremmani and Pacini, 2007) should have been internationally proven and integrated into therapy for a long time. But the substance is nearly not available in most countries.…”

Section: Discussionmentioning

confidence: 99%

Dihydrocodeine/Agonists for Alcohol Dependents

Ulmer

Müller

Frietsch³

2012

Front. Psychiatry

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Objective: Alcohol addiction too often remains insufficiently treated. It shows the same profile as severe chronic diseases, but no comparable, effective basic treatment has been established up to now. Especially patients with repeated relapses, despite all therapeutic approaches, and patients who are not able to attain an essential abstinence to alcohol, need a basic medication. It seems necessary to acknowledge that parts of them need any agonistic substance, for years, possibly lifelong. For >14 years, we have prescribed such substances with own addictive character for these patients. Methods: We present a documented best possible practice, no designed study. Since 1997, we prescribed Dihydrocodeine (DHC) to 102 heavily alcohol addicted patients, later, also Buprenorphine, Clomethiazole (>6 weeks), Baclofen, and in one case Amphetamine, each on individual indication. This paper focuses on the data with DHC, especially. The Clomethiazole-data has been submitted to a German journal. The number of treatments with the other substances is still low. Results: The 102 patients with the DHC treatment had 1367 medically assisted detoxifications and specialized therapies before! The 4 years-retention rate was 26.4%, including 2.8% successfully terminated treatments. In our 12-steps scale on clinical impression, we noticed a significant improvement from mean 3.7 to 8.4 after 2 years. The demand for medically assisted detoxifications in the 2 years remaining patients was reduced by 65.5%. Mean GGT improved from 206.6 U/l at baseline to 66.8 U/l after 2 years. Experiences with the other substances are similar but different in details. Conclusion: Similar to the Italian studies with GHB and Baclofen, we present a new approach, not only with new substances, but also with a new setting and much more trusting attitude. We observe a huge improvement, reaching an almost optimal, stable, long term status in around 1/4 of the patients already. Many further optimizations are possible.

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Suppression of Craving for γ-Hydroxybutyric Acid by Naltrexone Administration

Cited by 11 publications

References 30 publications

Sodium oxybate plus nalmefene for the treatment of alcohol use disorder: A case series

Sodium oxybate plus nalmefene for the treatment of alcohol use disorder: A case series

The therapeutic potential of gamma-hydroxybutyric acid for alcohol dependence: balancing the risks and benefits. A focus on clinical data

Dihydrocodeine/Agonists for Alcohol Dependents

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