Williams Steven H
Psychology Service, Veterans Affairs Medical Center, Lebanon, Pennsylvania 17042, USA.
Am Fam Physician. 2005 Nov 1;72(9):1775-80.
Medications for treating alcohol dependence primarily have been adjunctive interventions, and only three medications--disulfiram, naltrexone, and acamprosate--are approved for this indication by the U.S. Food and Drug Administration. Disulfiram, an aversive agent that has been used for more than 40 years, has significant adverse effects and compliance difficulties with no clear evidence that it increases abstinence rates, decreases relapse rates, or reduces cravings. In contrast, naltrexone, an anticraving agent, reduces relapse rates and cravings and increases abstinence rates. Acamprosate also reduces relapse rates and increases abstinence rates. Serotonergic and anticonvulsant agents promise to play more of a role in the treatment of alcohol dependence. Although not approved by the U.S. Food and Drug Administration for this indication, the anticonvulsant topiramate and several serotonergic agents (e.g., fluoxetine, ondansetron) have been shown in recent studies to increase abstinence rates and decrease drinking.
治疗酒精依赖的药物主要一直是辅助性干预措施，且只有三种药物——双硫仑、纳曲酮和阿坎酸——被美国食品药品监督管理局批准用于此适应症。双硫仑，一种已使用40多年的厌恶剂，有显著的不良反应且依从性差，没有明确证据表明它能提高戒酒率、降低复发率或减少渴望。相比之下，纳曲酮，一种抗渴望剂，能降低复发率和渴望，并提高戒酒率。阿坎酸也能降低复发率并提高戒酒率。5-羟色胺能药物和抗惊厥药物有望在酒精依赖治疗中发挥更大作用。尽管未被美国食品药品监督管理局批准用于此适应症，但抗惊厥药物托吡酯和几种5-羟色胺能药物（如氟西汀、昂丹司琼）在最近的研究中已显示能提高戒酒率并减少饮酒量。
