Improving clinical outcomes for naltrexone as a management of problem alcohol use

Abstract

Despite being a relatively effective and safe treatment, the clinical management of alcohol abuse/dependence by oral naltrexone can be compromised due to the patient's non‐compliance with daily use of this medication. Over the past decade an increasing body of research has suggested that the use of sustained release depot naltrexone preparations can overcome this issue and deliver improved clinical outcomes. However, at the same time, research findings from diverse areas of pharmacogenetics, neurobiology and behavioural psychology have also been converging to identify variables including genetic markers, patient psychosocial characteristics and drug use history differences, or clusters of these variables that play a major role in mediating the response of alcohol abuse/dependent persons to treatment by naltrexone. While this article does not attempt to review all available data pertaining to an individual alcohol dependent patient's response to treatment by naltrexone, it does identify relevant research areas and highlights the importance of data arising from them. The characterization of clinical markers, to identify those patients who are most likely to benefit from naltrexone and to tailor a more individual naltrexone treatment, will ultimately provide significant benefit to both patients and clinicians by optimizing treatment outcome.

A Genetic Animal Model of Alcoholism for Screening Medications to Treat Addiction

“…Characterization of these predictors and their antecedents has led to the development of different typologies and/or drinking profiles as well as subcategories of severity associated with a diagnosis of an AUD in the Diagnostic and Statistical Manual of Mental Disorders, 4 th and 5 th Editions (DSM-4, DSM-TR-4 and DSM-5, American Psychiatric Association, 1994, 2000, 2013; Babor et al, 1992; Cloninger, 1987; Conrod, Pihl, Stewart, & Dongier, 2000; Epstein, Kahler, McCrady, Lewis, & Lewis, 1995; Lesch & Walter 1996; Moss, Chen, & Yi, 2007; Prelipceanu & Mihailescu, 2005; Preuss, Watzke, & Wurst, 2014; Windle & Scheidt, 2004; Zucker, 1987). It has also been shown that an individual’s ranking within a particular typology predict’s the efficacy of certain pharmacotherapies (Cherpitel, Moskalewicz, & Swiatkiewicz, 2004; Dundon, Lynch, Pettinati, & Lipkin, 2004; Epstein et al, 1995; Forray & Sofuoglu, 2014; Hulse, 2012; Johnson, 2005, 2010; Johnson, Ait-Daoud, Ma, & Wang, 2003; Keating, 2013). Therefore, age-of-onset and pattern of drinking, recognizing that these are often correlated, have significant predictive validity for a life-time diagnosis of alcohol abuse or dependence and, in some cases, the effectiveness of pharmacotherapies to treat alcohol dependence.…”

New Biodegradable Poly(l-lactide)-Block-Poly(propylene adipate) Copolymer Microparticles for Long-Acting Injectables of Naltrexone Drug

“…Treatment by oral administration of NTX requires a daily administration and its efficacy can be compromised due to the patient's non-compliance. Indeed, 37% of patients discontinue the daily oral use of NTX by 12 weeks and more than 80% discontinue its use by six months [5]. Currently there are two major types of sustained-release formulations for NTX delivery: (a) injectable depot formulations for long-acting release (Naltrel ® , Vivitrol ® , and Depotrex ® ), and (b) surgically implantable pellets (Prodetoxone®, Wedgewood®, and O'Neil®) [6].…”

Contribution of Noradrenaline, Serotonin, and the Basolateral Amygdala to Alcohol Addiction: Implications for Novel Pharmacotherapies for AUDs

“…Although naltrexone was shown to be very effective with and without cognitive behavioral therapy, noncompliance with maintenance of drug regimen was shown to limit efficacy [50]. About 37% patients were reported to discontinue naltrexone therapy by 12 weeks and 80% by 6 months [50].…”