[Show abstract][Hide abstract] ABSTRACT: Alcohol use, abuse and dependence remain a pressing public health problem. Based on its mechanism of action, varenicline seemed to be a likely candidate for treating alcohol dependence.
Alcohol dependent subjects (n=40) were enrolled in a 13-week double-blind placebo controlled clinical trial. Subject visits were once per week. At each visit, subjects were tested for breath alcohol levels, provided self-report data on alcohol and nicotine use, and on mood and craving. In addition, subjects received once a week medical management (MM).
There was no difference between varenicline and placebo treated groups on any of the drinking outcomes. Compared to placebo-treated subjects, varenicline treated subjects had decreased rates of alcohol craving and cigarette smoking, as well as greater mood improvements during the later part of the study (weeks 6-13). In addition, among subjects who were cigarette smokers, those treated with varenicline were significantly less likely to report heavy drinking during the trial.
Although varenicline was not significantly more effective than placebo at reducing drinking during the trial, its effects on alcohol craving and mood suggest that future investigation of the mechanism of action of varenicline, as well as additional clinical studies may be warranted. In particular, the findings regarding the influence of smoking status on heavy drinking among varenicline-treated subjects should be investigated in future studies.
Drug and alcohol dependence 07/2013; · 3.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In recent years, the field of medication development aimed at treating alcoholism and drug dependence has benefited greatly from neuropsycho-pharmacologic research pertaining to glutamate antagonists. Acamprosate is the medication studied most extensively as pharmacotherapy for alcohol dependence. Although European studies have found acamprosate to be efficacious, studies in the United States have not. This discrepancy could be due to differences in the clinical picture of study participants. Important predictors of response to acamprosate treatment include prominent signs of physiologic dependence, negative family history, anxiety, later age of onset, and female gender. Other N-methyl-D-aspartate antagonists, including memantine, need to be studied further as potential pharmacotherapies for alcoholism. The novel compound topiramate, which is an antagonist at α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid and kainate glutamate receptors, has demonstrated efficacy in the treatment of alcoholism in an undifferentiated population. Further studies to establish this finding are ongoing. For drug addiction other than alcoholism, topiramate is the one glutamate antagonist that has shown the most promise in clinical popula-tions to date, particularly for cocaine-and nicotine-dependent individuals. Results from these studies, however, are preliminary and need to be con-firmed by additional research, which is currently under way. Needs Assessment: New medications are needed to treat substance Needs Assessment: New medications are needed to treat substance Needs Assessment: dependence because they address the underlying neurobiologic mechanisms of the addictive disorder and offer the possibility of improved outcomes over psychosocial treatments alone. Learning Objectives: • Describe the neurobehavioral aspects of alcohol and drug use. • Review the importance of neuromodulators of cortico-mesolimbic dopamine in reducing alcohol-or drug-using propensity. • Provide an overview of the clinical applications of antiglutaminergic medi-cations in treating alcohol, nicotine, and cocaine dependence. School of Medicine to ensure objectivity, balance, independence, transpar-ency, and scientific rigor in all CME-sponsored educational activities. All fac-ulty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audi-ence of their discussions of unlabeled or unapproved drugs or devices. This information will be available as part of the course material.
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