Campral scientific update |
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Curr Opin Psychiatry. 2007 May;20(3):222-7.
Assanangkornchai S, Srisurapanont M.
aDepartment of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand bDepartment of Psychiatry, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand.
The treatment of alcohol dependence.
PURPOSE OF REVIEW: The present review summarizes current research on the management of alcohol dependence, including pharmacotherapy, psychosocial interventions and treatment of alcohol dependence with comorbid psychiatric disorders. RECENT FINDINGS: Among recent studies, naltrexone has demonstrated the most consistent effect in reducing alcohol consumption in the context of behavioral therapy. In contrast to most previous studies, acamprosate did not show significant benefits on treatment outcomes relative to placebo. The combined use of naltrexone and acamprosate appeared to be safe and well tolerated but there was no additional therapeutic benefit. With the exception of topiramate, there are currently no new, effective medications for alcohol dependence. Of the psychosocial interventions, such as social behavior and network therapy, cognitive behavioral therapy, and motivational enhancement therapy, no one appears to be superior to another. Psychiatric comorbidity is common in alcohol-dependent patients; however, there are too few studies to effectively guide treatment practice. SUMMARY: Progress has been made with pharmacotherapy and psychosocial interventions for alcohol-dependent individuals. More research is needed, however, in developing newer medications and psychosocial interventions in alcohol-dependent populations and in those with comorbid psychiatric conditions, and to improve the strategies to engage patients in continuing care.
Addict Biol. 2007 Mar;12(1):35-50.
Heidbreder CA, Andreoli M, Marcon C, Hutcheson DM, Gardner EL, Ashby CR Jr.
Department of Neuropsychopharmacology, Centre of Excellence for Drug Discovery in Psychiatry, Verona, Italy.
Evidence for the role of dopamine D3 receptors in oral operant alcohol self-administration and reinstatement of alcohol-seeking behavior in mice.
The present study examined the effects of the acute intraperitoneal (i.p.) administration of the selective dopamine (DA) D(3) receptor antagonist SB-277011A (10, 20 or 30 mg/kg i.p.) on the oral operant self-administration of alcohol in male C57BL/6N mice. These effects were compared with those of naltrexone (0.5, 1 and 2 mg/kg i.p.) and acamprosate (100, 200 and 400 mg/kg i.p.). Compared with vehicle, the acute administration of SB-277011A (10 or 20 mg/kg) did not significantly alter the operant self-administration of alcohol, whereas the 30 mg/kg dose significantly reduced alcohol intake (g/kg), the number of reinforcers, and the number of active lever presses. The oral self-administration of alcohol was not significantly altered by the acute administration of either naltrexone or acamprosate, compared with vehicle-treated mice. SB-277011A, naltrexone and acamprosate were also tested in a model of drug/cue-triggered reinstatement of alcohol-seeking behavior. In this model, neither naltrexone (2 mg/kg) nor acamprosate (400 mg/kg) prevented relapse to alcohol-seeking behavior. In contrast, SB-277011A significantly reduced reinstatement of alcohol seeking in a dose-dependent manner. Provided these results can be extrapolated to humans, they suggest that selective DA D(3) receptor antagonists may be useful in the pharmacotherapeutic management of alcohol intake and prevention of relapse to alcohol-seeking behavior.
Ann Pharmacother. 2007 Apr;41(4):715-8.
Guzik P, Bankes L, Brown TM.
School of Medicine, University of Texas Health Science Center at San Antonio, USA.
Acamprosate and primitive reflexes.
OBJECTIVE: To describe 3 cases of patients with alcohol dependence whose primitive reflexes resolved upon initiation of acamprosate 666 mg 3 times daily. CASE SUMMARIES: A 57-year-old man had a long-standing history of alcohol dependence and a prominent snout reflex. The snout reflex resolved within 24 hours of starting treatment with acamprosate. A 45-year-old man with a long history of alcohol dependence had both a snout and a grasp reflex. These reflexes were present throughout 3 admissions for alcohol detoxification and continued until the end of his third admission, when he elected to begin treatment with acamprosate. Within 24 hours of starting treatment, the snout and grasp reflexes were absent. A 55-year-old man who drank heavily for 35 years presented with both a snout and a grasp reflex on admission. These persisted throughout his detoxification until the day after he had begun treatment with acamprosate. His primitive reflexes remained resolved through the next 4 days until discharge. All 3 of these patients remained on acamprosate at discharge. DISCUSSION: Alcohol dependence is a common, debilitating disorder. One of the difficulties in treating alcohol dependence is its adverse effect on the brain, as higher aspects of cortical function necessary to maintain abstinence are eroded by alcohol. Acamprosate is a drug intended to help prevent relapse among patients with alcohol dependence. Unexpectedly, acamprosate may resolve primitive reflexes--a neurologic finding that suggests cognitive impairment--among patients with alcohol dependence. CONCLUSIONS: Acamprosate may relieve snout and grasp reflexes among patients with alcohol dependence.
Addiction. 2006 Oct;101(10):1451-62.
Morley KC, Teesson M, Reid SC, Sannibale C, Thomson C, Phung N, Weltman M, Bell JR, Richardson K, Haber PS.
Central Clinical School of Medicine, University of Sydney, NSW, Australia.
Naltrexone versus acamprosate in the treatment of alcohol dependence: A multi-centre, randomized, double-blind, placebo-controlled trial.
AIM: To compare the efficacy of acamprosate and naltrexone in the treatment of alcohol dependence. DESIGN: A double-blind, placebo-controlled trial. SETTING: Three treatment centres in Australia. PARTICIPANTS: A total of 169 alcohol dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks. INTERVENTION: All subjects were offered manualized compliance therapy, a brief intervention that targets problems that may affect treatment compliance such as ambivalence and misperceptions about medication. MEASUREMENTS: Time to the first drink, time to first relapse, drinks per drinking day and cumulative abstinence. FINDINGS: In intention-to-treat analyses, there were no differences between groups on outcome measures of drinking, craving or biochemical markers. Similarly, analyses of the 94 subjects that completed the study in full and demonstrated 80% compliance, revealed no significant treatment effects. Differential treatment effects were identified after stratification according to scores on the Alcohol Dependence Scale (ADS) and Depression Anxiety and Stress Scale (DASS). A significant beneficial treatment effect on time to first relapse was revealed for subjects with 'no depression' allocated to naltrexone (n = 56; P < 0.01). In addition, a significant beneficial treatment effect was revealed in subjects with 'low dependence' allocated to naltrexone (n = 34; P < 0.05). CONCLUSIONS: The results of this study support the efficacy of naltrexone in the relapse prevention of alcoholism amongst those with low levels of clinical depression and alcohol dependence severity. No effect of acamprosate was found in our sample.
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Drug category:Alcohol addiction
 Campral scientific update
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