Initiating acamprosate within-detoxification versus post-detoxification in the treatment of alcohol dependence

Department of Psychiatry, University of Pennsylvania School of Medicine, 3900, Chestnut Street, Philadelphia, PA 19104, USA.
Addictive behaviors (Impact Factor: 2.76). 04/2009; 34(6-7):581-6. DOI: 10.1016/j.addbeh.2009.03.014
Source: PubMed


This trial compared the efficacy of acamprosate, started at the beginning of detoxification, to acamprosate started at the completion of detoxification, in the treatment of alcohol dependence.
This biphasic clinical trial consisted of a randomized, double-blind, placebo-controlled Detoxification Phase (DP), followed by a 10-week open-label Rehabilitation Phase (RP). Forty alcohol dependent patients were randomly assigned to receive either 1998 mg of acamprosate daily, or matching placebo, during the DP (5-14 days). After completing detoxification, all patients received open label acamprosate (1998 mg daily) in the RP. Outcome measures during the DP included: treatment retention, alcohol withdrawal, alcohol consumption, and oxazepam used. Outcome measures during the RP included: treatment retention and alcohol consumption.
There were no significant outcome differences between acamprosate and placebo-treated patients during the DP. Patients given acamprosate, compared to placebo, during the DP drank more alcohol in the RP.
Starting acamprosate at the beginning of detoxification did not improve DP outcomes. Starting acamprosate after detoxification was completed was associated with better drinking outcomes during subsequent alcohol rehabilitation treatment.

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    • "Currently, there are only three FDA-approved medications available for the treatment of alcohol dependence, disulfiram, naltrexone and acamprosate. They each have only limited effectiveness in select alcoholic patients, and they also have significant adverse effects such as fatigue, abdominal pain, diarrhea, nausea, vomiting, blurred vision, depression and dizziness7,8,9,10. This lack of choice in medicine often impacts the effective treatment of alcohol abuse in clinical practice1. "
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    • "A secondary analysis of COMBINE has shown that a longer period of pretreatment abstinence resulted in a poorer response with acamprosate (Gueorguieva et al., 2011) (Ib). Given this evidence and acamprosate's potential neuroprotective effect, we recommend it should be started during detoxification, despite Kampman et al. (2009) (Ib) reporting in a preliminary trial that some drinking outcomes may worsen. Currently the SPC recommends acamprosate be given for 1 year. "
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    • "Some investigators have suggested that a significant " placebo effect " in the COMBINE study might have masked any beneficial effects of acamprosate (Weiss et al., 2008), and that improvements in nondrinking related outcomes measures such as quality of life were in fact superior in acamprosate-versus placebo-treated patients in the COMBINE study (LoCastro et al., 2009). Others have suggested that initiation of acamprosate treatment following detoxification produces reductions in alcohol craving as opposed to when given during active alcohol consumption (Kampman et al., 2009), as was done in the COMBINE study. The requirement for three doses per day may be a compliance barrier for some patients. "
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