Current and Promising Pharmacotherapies, and Novel Research Target Areas in the Treatment of Alcohol Dependence: A Review

Abstract

Harmful alcohol use is a risk factor in more than 60 diseases and injuries resulting in approximately 2.5 million deaths per year worldwide. In the United States (US) and Europe, there are only a few medications approved for alcohol dependence (AD) however, these medications have only been moderately effective and there is a crucial need for more effective treatments. This review briefly summarizes research on currently approved medications for AD, as well as promising medications like topiramate, baclofen and ondansetron. Topiramate is likely the most promising new treatment for AD, however, further research is needed to determine the optimal dose and appropriate length of treatment. Baclofen, a GABA(B) agonist, is a promising medication as a treatment for AD, especially for patients with AD and severe liver disease. Ondansetron has shown promising results as a potential medication for AD, but only within a certain subtype of individuals. This review also discusses more recent findings on other potential pharmacotherapies for AD, such as serotonin-specific reuptake inhibitors (SSRIs; i.e. sertraline), aripiprazole and prazosin, as well as on some examples of other potentially interesting new neuropharmacological targets (i.e. cannabinoid receptors, CRF, NPY, ghrelin). Finally, the present review also discusses the attempts to personalize medication for AD treatment by alcohol typology and pharmacogenetics.

Activation of amylin receptors attenuates alcohol‐mediated behaviours in rodents

“…Importantly, amylin analogues like pramlintide for the treatment of diabetes and sCT products for the treatment of osteoporosis and Paget's disease are already commercially available. Providing that research on neurochemical mechanisms through which alcohol activates the mesolimbic dopamine reward link has led to identification of novel treatment targets (Edwards et al 2011;Engel & Jerlhag 2014) and in combination with our preclinical data, the aforementioned or similar agents could tentatively be used as potential treatment of alcohol dependence as well as other addiction disorders. …”

Contribuição de grupos de pesquisa brasileiros na avaliação de fármacos para o tratamento da dependência de álcool

“…Tem sido considerado como a mais promissora entre as novas alternativas farmacológicas para o alcoolismo apesar de ainda ser necessário determinar a dose terapêutica e o tempo apropriado de tratamento 17 . A gabapentina é um anticonvulsivante que interfere na neurotransmissão mediada por GABA que tem sido usado também no tratamento de dores de origem nervosa.…”

“…Destacase o estudo brasileiro 9 sobre a gabapentina, uma vez que ainda são poucos os artigos sobre a aplicação desse fármaco na dependência do álcool 18 . Por outro lado, não se encontrou artigos sobre estudos brasileiros com outros fármacos de interesse no tratamento do alcoolismo, como baclofen e ondansentron 17 .…”

Different Contributions of Dopamine D1 and D2 Receptor Activity to Alcohol Potentiation of Brain Stimulation Reward in C57BL/6J and DBA/2J Mice

“…Blunting the rewarding and reward-enhancing effects of acute alcohol remains a viable pharmacotherapeutic strategy to treat alcohol use disorders, particularly for individuals who are most sensitive to these alcohol effects (Heilig et al, 2010). Although the efficacy of classic neuroleptics remains limited by undesirable side effects, newer DA receptor antagonists that are proposed to modulate the balance between tonic and phasic DA levels, such as aripiprazole, or other classes of drugs that impact dopaminergic neurotransmission indirectly, such as ondansetron, may be more effective and behaviorally specific (Edwards et al, 2011).…”