Pharmacotherapy of alcohol dependence (Schweizer Archiv für Neurologie und Psychiatrie, 2011)
Autor: Michael Soyka
(pp, 12.10.2014)
Struktur des Inhalts
Englischer Abstract aus dem deutschen Original
Pharmacologically supported relapse prevention of alcohol dependence with so-called anticraving substances is still a relatively new clinical field. Apart from disulfiram, which when alcohol is consumed results in massive intolerance reactions, for many years there have been no promising pharmacological approaches to improving prognosis in alcohol dependence. By now there has been a clearcut improvement in knowledge of the neurobiological basis of alcohol dependence and basic addiction mechanisms, such as, for example, craving. A solidly evidence-based finding by now is that acamprosat reduces the risk of relapse in alcohol dependence by acting via glutamatergic neurons with largely good tolerance. The effectiveness of the opioid antagonist naltrexon in the treatment of alcohol dependence is also solidly evidence-based. Naltrexon’s main action is to lower the positive-reinforcing effect of alcohol vectored by opiate receptors. New clinically relevant developments may be another opioid antagonist, nalmefen, and the use of depot-naltrexon, which could markedly improve the compliance problem. A number of investigations of the two substances have been published or are under evaluation. Other substances for which at least first research results are available are GABA-B receptor agonist baclofen, the antiepileptics topiramat and gabapentin, daidzen, the drug derived from Chinese medicine which is probably an alcohol dehydrogenase inhibitor, and the atypical neuroleptic quetiapin. Substances resulting in modulation of the stress system may also be of clinical interest. To date, biologically-oriented addiction research has failed to produce a “magic bullet” to improve the prognosis or reduce the risk of relapse in alcohol dependence, but the first evidence-based therapeutic approaches exist.
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