Graham Robert, Wodak Alex D, Whelan Greg
St Vincent's Hospital, Sydney, NSW, Australia.
Med J Aust. 2002 Jul 15;177(2):103-7. doi: 10.5694/j.1326-5377.2002.tb04683.x.
Two pharmacotherapies recently introduced in Australia, acamprosate and naltrexone, provide a major advance in the treatment of severe alcohol dependence, a common condition leading to a considerable burden of illness and major costs to the community. Acamprosate and naltrexone reduce alcohol intake, and increase the likelihood and prolong the duration of abstinence (Level I evidence). Compared with naltrexone, the benefits of acamprosate have been confirmed in a larger number of studies involving larger numbers of patients with longer durations of follow-up. Unlike naltrexone, acamprosate appears to achieve a sustained benefit. There is no known interaction effect between alcohol and acamprosate or naltrexone. Both drugs are well tolerated, although naltrexone blocks the action of opioid analgesics. Adjunctive psychosocial treatment with close follow-up is required for acamprosate and recommended for naltrexone. As yet, no studies have reported a reduction in mortality following the use of any pharmacotherapy for alcohol dependence.
澳大利亚最近引进的两种药物疗法——阿坎酸和纳曲酮，在重度酒精依赖的治疗方面取得了重大进展。重度酒精依赖是一种常见病症，会给患者带来相当大的疾病负担，并给社会造成高昂成本。阿坎酸和纳曲酮能减少酒精摄入量，提高戒酒的可能性并延长戒酒时间（一级证据）。与纳曲酮相比，阿坎酸的疗效已在更多研究中得到证实，这些研究涉及更多患者，随访时间更长。与纳曲酮不同，阿坎酸似乎能带来持续的益处。目前尚无证据表明酒精与阿坎酸或纳曲酮之间存在相互作用。两种药物耐受性良好，不过纳曲酮会阻断阿片类镇痛药的作用。使用阿坎酸时需要辅助以密切随访的心理社会治疗，使用纳曲酮时建议如此。迄今为止，尚无研究报告称使用任何治疗酒精依赖的药物疗法后死亡率有所降低。
