Naltrexone Exerts a Favourable Effect on Plasma Lipids in Abstinent Patients With Alcohol Dependence

Abstract

Epidemiological studies suggest that abstinence periods in some patients with alcohol dependence may increase their cardiovascular risk via proatherogenic changes in plasma lipid levels. Because of this, drugs administered in withdrawal therapy should not exacerbate these effects. The aim of this study was to estimate the influence of naltrexone, carbamazepine, and lithium carbonate on plasma lipid levels in 160 alcohol-dependent males during withdrawal therapy. Plasma concentrations of total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and triglycerides (TGL) were determined every 2 weeks for 20 weeks. Pharmacotherapy (naltrexone 50 mg, carbamazepine 600-800 mg, lithium carbonate 500-1000 mg once per day or placebo) was given within the framework of a double-blind study between the fourth and twentieth weeks of the study. The results of 116 patients who maintained abstinence during the whole 20-week observation period were analysed. In patients treated with naltrexone significant decreases in TC (239 +/- 58 vs 216 +/- 52 mg/dl; P < 0.01) and TGL (125 +/- 68 vs 86 +/- 33 mg/dl; P < 0.02) concentrations after 16 weeks of pharmacotherapy were observed. In patients treated with carbamazepine, significant increases in TC (224 +/- 39 vs 243 +/- 54 mg/dl, P < 0.04) and HDL (40 +/- 10 vs 44 +/- 8 mg/dl, P < 0.01) after 16 weeks of pharmacotherapy were observed. After 16 weeks of pharmacotherapy, patients treated with naltrexone had lower mean TC (P < 0.03) and LDL-C (P < 0.01) concentrations than patients treated with carbamazepine, lower mean LDL-C levels than patients treated with lithium carbonate (149 +/- 54 vs 164 +/- 57 mg/dl, P < 0.01), and lower TGL concentrations than patients of the remaining pharmacotherapy groups. We conclude that naltrexone, by its hypolipaemic effect, could be useful for withdrawal therapy in alcoholic patients, because it may decrease the cardiovascular risk in abstinent patients with alcohol dependence by lipid mechanisms.

The effects of polyunsaturated fatty acids in alcohol dependence treatment - a double-blind, placebo-controlled pilot study

“…Also, in patients treated with naltrexone, there was a significant decrease in total cholesterol (TC) concentration after 16 weeks of pharmacotherapy. Patients treated with naltrexone had lower mean TC ( P < 0.03) and LDL-C ( P < 0.01) than patients of the remaining pharmacotherapy groups [33]. In our study, even with only 12 weeks of treatment, a trend in naltrexone effects over PUFAS, TC and LDL-C could be observed (Figures 2 and 3).…”

“…This effect could be related to the hipolipaemic effect cased by naltrexone, previously reported in both animal and human studies. Naltrexone prevented the stress-induced increase in total and LDL cholesterol in rats during stress caused by immobilization and a decrease in HDL-C levels [33]. Also, in patients treated with naltrexone, there was a significant decrease in total cholesterol (TC) concentration after 16 weeks of pharmacotherapy.…”

Meta‐analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?

“…Some of the studies used “atypical” designs, including (a) three studies with targeted naltrexone (participants took naltrexone when they felt they would be in a high-risk situation) in addition to, or instead of, daily naltrexone (25, 61, 62), (b) two studies in which all participants received naltrexone in Phase 1 before moving on to Phase 2 which randomized to naltrexone versus placebo (63, 64), (c) one naltrexone study in which all participants also received sertraline (65), (d) two naltrexone studies which only provided effect size data for completers (66, 67), and (e) four naltrexone studies that administered the medication either in an inpatient setting or in mixed settings (inpatient and/or outpatient) (68-71). Our tests indicated that these studies were not outliers (i.e., did not unduly influence overall effect sizes).…”

Naltrexone changes the expression of lipid metabolism‐related proteins in the endoplasmic reticulum stress induced hepatic steatosis in mice

“…reported that morphine exposure elevated plasma LDL, VLDL, total cholesterol and β lipoprotein, which were reversed by naltrexone administration . In another report, it has been shown that pharmacotherapy with naltrexone decreased plasma total cholesterol, triglyceride, LDL and VLDL in abstinent alcoholic patients . Also, the mu‐ and kappa‐opioid receptors may play a role in the tendency toward obesity and impaired glucose tolerance .…”