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Naltrexone versus acamprosate:: One year follow-up of alcohol dependence treatment

ALCOHOL AND ALCOHOLISM 2001年第5期36卷 419-425页

作者： Rubio, G Jiménez-Arriero, MA Ponce, G Palomo, T Hosp Univ 12 Octubre Serv Psiquiatria Madrid 28041 Spain

Naltrexone and acamprosate reduce relapse in alcohol dependence. They have not yet been compared in a published trial. The aim of this study was to compare the efficacy of these compounds in conditions similar to those in routine clinical practice. Random allocation to a year of treatment with naltrexone (50 mg/day) or acamprosate (1665-1998 mg/day) was made in 157 recently detoxified alcohol-dependent men with moderate dependence (evaluated using the Addictions Severity Index and Severity of Alcohol Dependence Scale). All were patients whom a member of the family would accompany regularly to appointments. Alcohol consumption, craving and adverse events were recorded weekly for the first 3 months, and then bi-weekly, by the treating psychiatrist who was not blinded. At 3-monthly intervals, investigators who were blinded to the treatment documented patients' alcohol consumption based on patients' accounts, information given by the psychiatrists when necessary, and reports from patients' families. Serum gamma-glutamyltransferase (GGT) was also measured. Efforts were made to sustain the blindness of the investigators. The same investigator did not assess the same patient twice. The integrity of the blindness was not checked. There was no difference between treatments in mean time to first drink (naltrexone 44 days, acamprosate 39 days) but the time to first relapse (five or more drinks in a day) was 63 days (naltrexone) versus 42 days (acamprosate) (P = 0.02). At the end of 1 year, 41% receiving naltrexone and 17% receiving acamprosate had not relapsed (P = 0.0009). The cumulative number of days of abstinence was significantly greater, and the number of drinks consumed at one time and severity of craving were significantly less, in the naltrexone group compared to the acamprosate group, as was the percentage of heavy drinking days (P = 0.038). More patients in the acamprosate than the naltrexone group were commenced on disulfiram during the study. Naltrexone patients a

关键词：戒酒药/治疗应用慢性酒精中毒/血液慢性酒精中毒/药物疗法慢性酒精中毒/预防和控制方差分析行为成瘾/血液行为成瘾/药物疗法卡方分布随访研究纳曲酮/治疗应用麻醉品拮抗药/治疗应用二级预防单盲法存活率分析牛磺酸/类似物和衍生物牛磺酸/治疗应用 γ-谷氨酰转移酶/血液成年人人类男(雄)性中年人

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New therapies for alcohol problems: Application to primary care

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AMERICAN JOURNAL OF MEDICINE 2000年第3期108卷 227-237页

作者： Fiellin, DA Reid, MC O'Connor, PG Yale Univ Sch Med Dept Internal Med New Haven CT 06520 USA Vet Affairs Connecticut Healthcare Syst Clin Epidemiol Unit West Haven CT USA

Primary care physicians are frequently involved in the longitudinal care of patients with alcohol problems and in helping patients to decrease their alcohol consumption. Recent clinical trials provide evidence in support of new treatment strategies for these patients. Brief interventions have been used successfully to reduce alcohol consumption in patients with hazardous and harmful drinking. Twelve-step facilitation, cognitive behavioral, and motivational enhancement therapies have produced sustained drinking reductions in patients with alcohol dependence. Pharmacologic therapies, such as naltrexone and acamprosate, have been effective in decreasing alcohol consumption when provided along with psychosocial counseling in patients with alcohol dependence. The current review highlights the application of these new therapies to primary care physicians' efforts on behalf of their patients with alcohol problems. (C) 2000 by Excerpta Medica, Inc.

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Acamprosate during and after acute alcohol withdrawal: A double-blind placebo-controlled study in spain

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ALCOHOL AND ALCOHOLISM 2001年第5期36卷 413-418页

作者： Gual, A Lehert, P Hosp Clin Barcelona IMD Unitat Alcohol Gen Barcelona 08036 Spain Univ Mons FUCAM Dept Stat B-7000 Mons Belgium

To test acamprosate's role as an aid in preventing relapse after detoxification, 296 alcohol-dependent patients entered a prospective, multicentre, randomized, double-blind, parallel comparison of acamprosate treatment consisting of two 333 mg tablets given three times daily for 180 days with matching placebo treatment. Unlike previous studies, acamprosate was prescribed from the start of alcohol withdrawal, rather than after the detoxification process. During the treatment period, 110 patients dropped out. The two treatment groups were balanced with regard to baseline values and reasons for discontinuation. There was no difference between the groups in the severity of withdrawal symptoms as measured by the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol scale). Acamprosate given during withdrawal did not cause unwanted effects. The cumulative abstinence duration (CAD, main end-point) was 19 days longer in the acamprosate treatment group than the placebo treatment group (analysis of variance on ranks, P = 0.0006) and the stable recovery duration, defined as the number of abstinent days between the last relapse into any drinking and the end of the trial, was 16 days longer in the acamprosate treatment group (P = 0.021). Continuous abstinence, estimated by survival analysis on time to first relapse, was achieved by 35% of acamprosate-treated patients and 26% of placebo-treated patients (log rank P = 0.068). The geometric mean of the ratio final/baseline values for serum carbohydrate-deficient transferrin was 0.802 (placebo) and 0.733 (acamprosate) (P = 0.059). The geometric mean of the ratio final/baseline values for serum gamma -glutamyltransferase was 0.496 (placebo) and 0.415 (acamprosate) (P = 0.024) which corroborated the greater abstinence reported by the acamprosate group.

关键词：戒酒药/治疗应用慢性酒精中毒/药物疗法慢性酒精中毒/心理学方差分析行为成瘾/药物疗法行为成瘾/心理学双盲法结果评价(卫生保健) 安慰剂前瞻性研究西班牙统计学非参数物质戒断综合征/药物疗法物质戒断综合征/心理学牛磺酸/类似物和衍生物牛磺酸/治疗应用成年人人类男(雄)性中年人

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Evaluation and management of chronic alcohol abuse

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HOSPITAL PRACTICE 1999年第4期34卷 95-+页

作者： Kick, SD Univ Colorado Sch Med Denver CO USA

Alcohol abuse can be treated with diverse modalities that include drugs, behavioral modification, supportive therapy, and inpatient detoxification, Drugs and motivational programs have been especially important. The primary care physician may be the most effective mediator of change;brief advice or support can produce significant results.

关键词：戒酒药/治疗应用酒精中毒/诊断酒精中毒/治疗行为疗法慢性病双硫仑/治疗应用美国人类

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Physical compatibility of 10% alcohol in 5% dextrose injection with selected drugs during simulated Y-site administration

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2000年第24期57卷 2286-2287页

作者： Thoma, LA Johnson-Singh, A Wood, GC Wolfe, JL Univ Tennessee Dept Pharmaceut Sci Memphis TN 38163 USA

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