Article

New pharmacological approaches for the treatment of alcoholism

Technische Universität München, München, Bavaria, Germany
Expert Opinion on Pharmacotherapy (Impact Factor: 3.09). 01/2007; 7(17):2341-53. DOI: 10.1517/14656566.7.17.2341
Source: PubMed

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.

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    • "Expressed as homotetrameric protein with subunits of B54 kDa in the mitochondrial matrix, ALDH2 is thought to be essential for the detoxification of acetaldehyde produced during ethanol oxidation. About 40% of the East-Asian population that express a low-activity mutant (Glu487Lys) of ALDH2 (Larson et al., 2007) exhibit significantly lowered alcohol tolerance due to adverse effects of acetaldehyde accumulation (Crabb et al., 1989), and the ALDH inhibitor disulfiram is still approved in many countries as deterrent for the aversive pharmacotherapy of alcohol dependence (Soyka and Roesner, 2006). "
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