Medical University of South Carolina, Institute of Psychiatry, SC 29425, USA.
Am J Psychiatry. 2011 Jul;168(7):709-17. doi: 10.1176/appi.ajp.2011.10101436. Epub 2011 Mar 31.
Naltrexone, an efficacious medication for alcohol dependence, does not work for everyone. Symptoms such as insomnia and mood instability that are most evident during early abstinence might respond better to a different pharmacotherapy. Gabapentin may reduce these symptoms and help prevent early relapse. This clinical trial evaluated whether the combination of naltrexone and gabapentin was better than naltrexone alone and/or placebo during the early drinking cessation phase (first 6 weeks), and if so, whether this effect persisted.
A total of 150 alcohol-dependent individuals were randomly assigned to a 16-week course of naltrexone alone (50 mg/day [N=50]), naltrexone (50 mg/day) with gabapentin (up to 1,200 mg/day [N=50]) added for the first 6 weeks, or double placebo (N=50). All participants received medical management.
During the first 6 weeks, the naltrexone-gabapentin group had a longer interval to heavy drinking than the naltrexone-alone group, which had an interval similar to that of the placebo group; had fewer heavy drinking days than the naltrexone-alone group, which in turn had more than the placebo group; and had fewer drinks per drinking day than the naltrexone-alone group and the placebo group. These differences faded over the remaining weeks of the study. Poor sleep was associated with more drinking in the naltrexone-alone group but not in the naltrexone-gabapentin group, while a history of alcohol withdrawal was associated with better response in the naltrexone-gabapentin group.
The addition of gabapentin to naltrexone improved drinking outcomes over naltrexone alone during the first 6 weeks after cessation of drinking. This effect did not endure after gabapentin was discontinued.
纳曲酮是一种有效的酒精依赖治疗药物，但并非对所有人都有效。在戒断早期最明显的失眠和情绪不稳定等症状可能对其他药物治疗反应更好。加巴喷丁可能会减轻这些症状并帮助预防早期复发。本临床试验评估了在早期戒断阶段（前 6 周），纳曲酮与加巴喷丁联合使用是否优于单独使用纳曲酮和/或安慰剂，以及如果是这样，这种效果是否持续。
共 150 名酒精依赖者被随机分配到为期 16 周的纳曲酮单独治疗（50mg/天[N=50]）、前 6 周加用纳曲酮（50mg/天）和加巴喷丁（最高 1200mg/天[N=50]）或双安慰剂（N=50）组。所有参与者都接受了医疗管理。
在前 6 周内，纳曲酮-加巴喷丁组的重度饮酒间隔时间长于单独使用纳曲酮组，而后者的间隔时间与安慰剂组相似；重度饮酒天数少于单独使用纳曲酮组，而后者又多于安慰剂组；且每日饮酒量少于单独使用纳曲酮组和安慰剂组。这些差异在研究的剩余周内逐渐消失。纳曲酮单独组睡眠质量差与饮酒量增加相关，而纳曲酮-加巴喷丁组则无此相关性，且酒精戒断史与纳曲酮-加巴喷丁组的反应更好相关。
在停止饮酒后的前 6 周内，加巴喷丁联合纳曲酮可改善单独使用纳曲酮的饮酒结局。加巴喷丁停药后，这种效果并未持续。
