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#1
12.04.2005, 14:20
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Naltrexone aids fight against alcoholism
Long-acting injections of the drug naltrexone, combined with psychotherapy, have proven successful in fighting alcohol dependence, a study says.
The drug is effective on a once-a-month basis, according to a study in the Journal of the American Medical Association by a Yale School of Medicine researcher. "The decision to take medication can wane over time," said Stephanie O'Malley, professor of psychiatry and director of the Division of Substance Abuse Research at the Connecticut Mental Health Center at Yale. "This provides coverage for an entire month." Alcohol dependence is believed to contribute to more than 100,000 preventable deaths a year nationally. In a trial conducted at 24 sites, 627 alcohol dependent patients were randomly assigned to receive either an injection of long-acting naltrexone or a placebo injection. Long-acting naltrexone was associated with a reduction in heavy drinking within the first month of treatment and this response was maintained over the six-month treatment period. --------------------------------------- JAMA. 2005 Apr 6;293(13):1617-25. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. Garbutt JC, Kranzler HR, O'Malley SS, Gastfriend DR, Pettinati HM, Silverman BL, Loewy JW, Ehrich EW; Vivitrex Study Group. Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7160, USA. CONTEXT: Alcohol dependence is a common disorder associated with significant morbidity and mortality. Naltrexone, an opioid antagonist, has been shown to be effective for treatment of alcohol dependence. However, adherence to daily oral pharmacotherapy can be problematic, and clinical acceptance and utility of oral naltrexone have been limited. OBJECTIVE: To determine efficacy and tolerability of a long-acting intramuscular formulation of naltrexone for treatment of alcohol-dependent patients. DESIGN, SETTING, AND PARTICIPANTS: A 6-month, randomized, double-blind, placebo-controlled trial conducted between February 2002 and September 2003 at 24 US public hospitals, private and Veterans Administration clinics, and tertiary care medical centers. Of the 899 individuals screened, 627 who were diagnosed as being actively drinking alcohol-dependent adults were randomized to receive treatment and 624 received at least 1 injection. INTERVENTION: An intramuscular injection of 380 mg of long-acting naltrexone (n = 205) or 190 mg of long-acting naltrexone (n = 210) or a matching volume of placebo (n = 209) each administered monthly and combined with 12 sessions of low-intensity psychosocial intervention. MAIN OUTCOME MEASURE: The event rate of heavy drinking days in the intent-to-treat population. RESULTS: Compared with placebo, 380 mg of long-acting naltrexone resulted in a 25% decrease in the event rate of heavy drinking days (P = .03) and 190 mg of naltrexone resulted in a 17% decrease (P = .07). Sex and pretreatment abstinence each showed significant interaction with the medication group on treatment outcome, with men and those with lead-in abstinence both exhibiting greater treatment effects. Discontinuation due to adverse events occurred in 14.1% in the 380-mg and 6.7% in the 190-mg group and 6.7% in the placebo group. Overall, rate and time to treatment discontinuation were similar among treatment groups. CONCLUSIONS: Long-acting naltrexone was well tolerated and resulted in reductions in heavy drinking among treatment-seeking alcohol-dependent patients during 6 months of therapy. These data indicate that long-acting naltrexone can be of benefit in the treatment of alcohol dependence. 
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#3
26.05.2005, 16:02
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Цитата:
Так же как и от Acamprosatum, практически мало толку.
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#4
26.05.2005, 16:06
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CNS Drugs. 2005;19(5):445-64.
Acamprosate: a review of its use in the maintenance of abstinence in patients with alcohol dependence. Scott LJ, Figgitt DP, Keam SJ, Waugh J. Adis International Limited, Auckland, New Zealand. Acamprosate (Campral((R)) delayed-release tablet), a synthetic compound with a similar structure to that of the neurotransmitter GABA and the neuromodulator taurine, facilitates the maintenance of abstinence in detoxified alcohol-dependent patients. Although the precise mechanism(s) of action of the drug remains to be fully elucidated, it appears that it most likely involves beneficial modulation of the glutamatergic neurotransmitter system, including antagonism of the mGLu5 metabotropic glutamate receptor, to counteract the imbalance between the glutamatergic and GABAergic systems associated with chronic alcohol exposure and alcohol withdrawal.In several double-blind, placebo-controlled trials of up to 12 months' duration, acamprosate effectively maintained complete abstinence in detoxified alcohol-dependent patients, irrespective of disease severity or the type of psychosocial support. The drug showed better efficacy than placebo and was very well tolerated. Limited data from a relatively well designed trial indicate that the drug has similar efficacy to that of naltrexone and that combination therapy with these two agents provides better efficacy than acamprosate monotherapy, although multicentre direct head-to-head investigations are required to fully establish the potential of this combination. The drug may be particularly useful in those with hepatic impairment and/or liver disease. Thus, in combination with psychosocial and behavioural management programmes, acamprosate is a promising option for the maintenance of abstinence in alcohol-dependent patients after alcohol withdrawal.
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#5
26.05.2005, 17:29
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Цитата:
просто не принимают, у процентов 10-15 довольно сильные побочные действия. Feeney GF, Connor JP. : Review: acamprosate and naltrexone are safe and effective but have low compliance rates for people with alcohol dependence. Evid Based Ment Health. 2005 Feb;8(1):14.
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Линейный вид
