Department of Internal Medicine, Institute of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo Gemelli 8, 00168 Rome, Italy.
CNS Drugs. 2013 Apr;27(4):287-99. doi: 10.1007/s40263-013-0043-4.
Alcohol dependence represents a chronic and relapsing disease affecting nearly 10 % of the general population both in the USA and in Europe, with a widespread burden of morbidity and mortality. Alcohol dependence represents the most common cause of liver damage in the Western world. Although alcoholic liver disease is associated primarily with heavy drinking, continued alcohol consumption, even in low doses after the onset of liver disease, increases the risk of severe consequences, including mortality. Consequently, the ideal treatment of patients affected by alcohol dependence and alcoholic liver disease should aim at achieving long-term total alcohol abstinence and preventing relapse. The aim of the present review is to provide an update on the management of alcohol dependence in patients with alcoholic liver disease. Increasing evidence suggests the usefulness of psychosocial interventions and medications combined in order to reduce alcohol intake, promote abstinence and prevent relapse in alcohol-dependent patients. Disulfiram, naltrexone and acamprosate have been approved for this indication; gamma-hydroxybutyric acid (GHB) is approved in Italy and Austria. However, these drugs have not been tested in patients with advanced liver disease. Amongst other emerging pharmacotherapies for alcoholism, topiramate, ondansetron, and baclofen seem the most promising ones. Both topiramate and ondansetron have a safe profile in alcoholic patients; however, none of them has been tested in alcoholic patients with advanced liver disease. To date, baclofen represents the only anti-craving medication formally tested in a randomized clinical trial in alcoholic patients affected by liver cirrhosis, although additional confirmatory studies are warranted.
酒精依赖症是一种慢性且易复发的疾病，在美国和欧洲，有近 10%的普通人群受到影响，其发病率和死亡率都很高。酒精依赖症是西方世界最常见的肝脏损伤原因。尽管酒精性肝病主要与大量饮酒有关，但即使在肝病发作后继续低剂量饮酒，也会增加出现严重后果的风险，包括死亡。因此，受酒精依赖和酒精性肝病影响的患者的理想治疗方法应该是实现长期完全戒酒并预防复发。本综述的目的是提供酒精性肝病患者酒精依赖症管理的最新信息。越来越多的证据表明，联合使用心理社会干预和药物可以减少饮酒量、促进戒酒并预防酒精依赖患者复发。双硫仑、纳曲酮和阿坎酸已被批准用于该适应症；γ-羟基丁酸（GHB）在意大利和奥地利被批准使用。然而，这些药物尚未在晚期肝病患者中进行过测试。在其他新兴的酒精中毒药物治疗中，托吡酯、昂丹司琼和巴氯芬似乎最有前途。托吡酯和昂丹司琼在酒精性患者中都具有安全的特性；然而，它们都没有在晚期肝病的酒精性患者中进行过测试。迄今为止，巴氯芬是唯一一种在随机临床试验中经过正式测试的抗渴求药物，适用于患有肝硬化的酒精性患者，尽管还需要额外的确认性研究。
