Ray Lara A, Courtney Kelly E, Ghahremani Dara G, Miotto Karen, Brody Arthur, London Edythe D
Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA,
Psychopharmacology (Berl). 2014 Oct;231(19):3843-53. doi: 10.1007/s00213-014-3519-0. Epub 2014 Apr 15.
Heavy-drinking smokers constitute a sizeable and hard-to-treat subgroup of smokers, for whom tailored smoking cessation therapies are not yet available.
The present study used a double-blind, randomized, 2 × 2 medication design, testing varenicline alone (VAR; 1 mg twice daily), low dose naltrexone alone (L-NTX; 25 mg once daily), varenicline plus naltrexone, and placebo for effects on cigarette craving and subjective response to alcohol and cigarettes in a sample (n = 130) of heavy-drinking daily smokers (≥10 cigarettes/day).
All participants were tested after a 9-day titration period designed to reach a steady state on the target medication. Testing was completed at 12 h of nicotine abstinence, after consuming a standard dose of alcohol (target breath alcohol concentration = 0.06 g/dl) and after smoking the first cigarette of the day.
The combination of VAR + L-NTX was superior to placebo, and at times superior to monotherapy, in attenuating cigarette craving, cigarette and alcohol "high," and in reducing ad-lib consumption of both cigarettes and alcohol during the 9-day medication titration period.
These preliminary findings indicate that clinical studies of the combination of VAR + L-NTX for heavy drinkers trying to quit smoking are warranted and may ultimately improve clinical care for this sizeable and treatment-resistant subgroup of smokers.
重度饮酒吸烟者是吸烟者中规模可观且难以治疗的一个亚组，目前尚无针对他们的量身定制的戒烟疗法。
本研究采用双盲、随机、2×2药物设计，在一个每日重度饮酒吸烟者样本（n = 130，每天≥10支香烟）中，测试单独使用伐尼克兰（VAR；每日两次，每次1毫克）、单独使用低剂量纳曲酮（L-NTX；每日一次，25毫克）、伐尼克兰加纳曲酮以及安慰剂对香烟渴望、对酒精和香烟的主观反应的影响。
所有参与者在一个为期9天的滴定期后进行测试，该滴定期旨在使目标药物达到稳态。测试在尼古丁戒断12小时后、饮用标准剂量酒精（目标呼气酒精浓度 = 0.06克/分升）后以及吸当日第一支香烟后完成。
在9天的药物滴定期内，VAR + L-NTX组合在减轻香烟渴望、香烟和酒精“快感”以及减少香烟和酒精的随意摄入量方面优于安慰剂，且有时优于单一疗法。
这些初步研究结果表明，有必要对VAR + L-NTX组合用于试图戒烟的重度饮酒者进行临床研究，这最终可能改善对这个规模可观且难治的吸烟者亚组的临床护理。
