Soyka Michael, Chick Jonathan
Psychiatric Hospital, University of Munich, Munich, Germany.
Am J Addict. 2003;12(s1):s69-s80. doi: 10.1111/j.1521-0391.2003.tb00497.x.
In thirteen of sixteen placebo-controlled trials in Europe, acamprosate increased abstinence in detoxified alcohol-dependent patients. It is approved in most EU countries. Its action at N-methyl-D-aspartate (NMDA) receptors appears to account for many of its effects. The number needed to treat in the fifteen trials suitable for meta-analysis has been calculated at 8.15. Trials of naltrexone in Europe have shown less clear evidence of efficacy than trials of acamprosate, whether abstinence or relapse to heavy drinking is used as the outcome criterion. With reduction in heavy drinking days as the criterion, naltrexone compared favorably to acamprosate in an open study in moderate alcohol dependence; one double-blind study has pointed to an advantage of the combination of naltrexone with acamprosate over either drug. To date, there are no trials published of nalmefene in European clinics. While many centers routinely offer a trial of acamprosate to newly detoxified patients aiming for abstinence, naltrexone usage varies. Some centers suggest naltrexone not only for patients aiming for abstinence but also for patients for whom continued drinking is a therapeutic possibility or a clinical inevitability.
在欧洲进行的16项安慰剂对照试验中，有13项显示阿坎酸能提高已戒酒的酒精依赖患者的戒酒成功率。它在大多数欧盟国家已获批准。其对N-甲基-D-天冬氨酸（NMDA）受体的作用似乎是其诸多效果的原因所在。在适合进行荟萃分析的15项试验中，计算得出的治疗所需人数为8.15。在欧洲，纳曲酮试验所显示的疗效证据不如阿坎酸试验明确，无论以戒酒还是复饮重度饮酒作为结果标准都是如此。以减少重度饮酒天数为标准，在一项针对中度酒精依赖的开放性研究中，纳曲酮与阿坎酸相比效果良好；一项双盲研究表明，纳曲酮与阿坎酸联合使用比单独使用任何一种药物都更具优势。迄今为止，欧洲诊所尚未发表有关纳美芬的试验报告。虽然许多中心通常会为旨在戒酒的新戒酒患者提供阿坎酸试验，但纳曲酮的使用情况各不相同。一些中心建议，纳曲酮不仅适用于旨在戒酒的患者，也适用于那些继续饮酒是一种治疗选择或临床必然情况的患者。
