Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review

Carmen, Bouza; Magro, Angeles; Ana, Muñoz; María, Amate José

doi:10.1111/j.1360-0443.2004.00763.x

Cited by 425 publications

(158 citation statements)

References 65 publications

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“…MOR blockade in the ventral tegmental area inhibits dopamine release following alcohol intake and opioid antagonists reduce alcohol intake in rodents (Mitchell et al 2009). Consistent with this preclinical literature, naltrexone has been shown to have a small‐to‐moderate effect size in reducing alcohol use in some (Garbutt et al 1999; Bouza et al 2004) but not all studies (Krystal et al 2001). In heroin dependence, naltrexone blocks the physiological and psychological effects of heroin (Navaratnam et al 1994; Brewer 2002; Brewer & Streel 2010), preventing relapse, particularly in the early detoxification phase (Foster, Brewer, & Steele 2003).…”

Section: Introductionmentioning

confidence: 62%

Naltrexone ameliorates functional network abnormalities in alcohol‐dependent individuals

et al. 2017

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Naltrexone, an opioid receptor antagonist, is commonly used as a relapse prevention medication in alcohol and opiate addiction, but its efficacy and the mechanisms underpinning its clinical usefulness are not well characterized. In the current study, we examined the effects of 50‐mg naltrexone compared with placebo on neural network changes associated with substance dependence in 21 alcohol and 36 poly‐drug‐dependent individuals compared with 36 healthy volunteers. Graph theoretic and network‐based statistical analysis of resting‐state functional magnetic resonance imaging (MRI) data revealed that alcohol‐dependent subjects had reduced functional connectivity of a dispersed network compared with both poly‐drug‐dependent and healthy subjects. Higher local efficiency was observed in both patient groups, indicating clustered and segregated network topology and information processing. Naltrexone normalized heightened local efficiency of the neural network in alcohol‐dependent individuals, to the same levels as healthy volunteers. Naltrexone failed to have an effect on the local efficiency in abstinent poly‐substance‐dependent individuals. Across groups, local efficiency was associated with substance, but no alcohol exposure implicating local efficiency as a potential premorbid risk factor in alcohol use disorders that can be ameliorated by naltrexone. These findings suggest one possible mechanism for the clinical effects of naltrexone, namely, the amelioration of disrupted network topology.

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Section: Introductionmentioning

confidence: 62%

Naltrexone ameliorates functional network abnormalities in alcohol‐dependent individuals

et al. 2017

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“…Research conducted in the 1990s and early 2000s demonstrated superior outcomes for acamprosate relative to placebo (Kiefer et al, 2003;Whitworth et al, 1996) and confi rmed its safety (Carmen et al, 2004). Other research, including an Australian study (Morley et al, 2006;Richardson et al, 2008) and the large U.S.…”

mentioning

confidence: 99%

“…COMBINE Study (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence; Anton et al, 2006;Donovan et al, 2008), did not fi nd improvements in drinking outcomes. Overall, however, meta-analyses of randomized clinical trials show that, relative to placebo, acamprosate improves both the rate and duration of continuous abstinence (Carmen et al, 2004) and may be more benefi cial than naltrexone for these specifi c outcomes (Maisel et al, 2013).…”

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confidence: 99%

Dissemination, Adoption, and Implementation of Acamprosate for Treating Alcohol Use Disorders

Knudsen

Roman

2014

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Acamprosate has been available in the United States for treating alcohol use disorders (AUDs) for nearly a decade, yet few studies have examined its use within AUD treatment organizations. In addition to describing dissemination and adoption of acamprosate, this study provides novel data regarding organizational processes that underlie its implementation within adopting programs. Method: Data were drawn from interviews with leaders of a nationally representative sample of 307 organizations delivering AUD treatment. Quantitative indicators of organizational characteristics, dissemination, adoption, and implementation of acamprosate, as well as qualitative measures of implementation processes, were measured during face-to-face interviews. Results: Only 18.0% (n = 55) of sampled organizations had adopted acamprosate for treating AUDs, and adoption was positively associated with accreditation, having a physician on staff, receiving information about acamprosate via pharmaceutical representatives, and learning about this medication from other treatment providers. Within adopting programs, an average of 6.0% of AUD patients were currently receiving acamprosate. Numerous implementation challenges were identifi ed, including appropriate patient selection, patient reluctance to be prescribed acamprosate, suboptimal adherence, its costs, and limited counselor training. Conclusions:The limited adoption and implementation of acamprosate likely limits the potential public health impact of this adjunct to AUD treatment. Research integrating the perspectives of organizational leaders, medical professionals, and patients is needed to determine whether specifi c strategies can address the implementation challenges identifi ed in the current study and increase use of acamprosate in specialty AUD treatment settings. (J. Stud. Alcohol Drugs, 75, 467-475, 2014)

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“…However, there is solid evidence today that pharmacological treatments can prolong the time to relapse following cessation of heavy drinking or decrease the number of heavy drinking days (Bouza, Angeles, Munoz & Amate, 2004). Nevertheless, the fact that ethanol interacts with a great number of neurotransmission systems, along with the genetic and individual factors of alcoholic patients, could explain that there is not a single effective treatment for alcohol dependence.…”

Section: Pharmacological Treatments For Alcoholismmentioning

confidence: 97%

Alteraciones neurobiológicas en el alcoholismo: revisión

Erdozain

Callado

2014

Adicciones

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The exact mechanism by which ethanol exerts its effects on the brain is still unknown. However, nowadays it is well known that ethanol interacts with specific neuronal membrane proteins involved in signal transmission, resulting in changes in neural activity. In this review different neurochemical alterations produced by ethanol are described. Primarily, ethanol interacts with two membrane receptors: GABA A and NMDA ion channel receptors. Ethanol enhances the GABA action and antagonizes glutamate action, therefore acting as a CNS depressant. In addition, ethanol affects most other neurochemical and endocrine systems. In regard to the brain reward system, both dopaminergic and opioid system are affected by this drug. Furthermore, the serotonergic, noradrenergic, corticotropinreleasing factor and cannabinoid systems seem to play an important role in the neurobiology of alcoholism. At last but not least, ethanol can also modulate cytoplasmic components, including the second messengers. We also review briefly the different actual and putative pharmacological treatments for alcoholism, based on the alterations produced by this drug.

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Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review

Cited by 425 publications

References 65 publications

Naltrexone ameliorates functional network abnormalities in alcohol‐dependent individuals

Naltrexone ameliorates functional network abnormalities in alcohol‐dependent individuals

Dissemination, Adoption, and Implementation of Acamprosate for Treating Alcohol Use Disorders

Alteraciones neurobiológicas en el alcoholismo: revisión

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