Caputo Fabio, Maremmani Angelo G I, Addolorato Giovanni, Domenicali Marco, Zoli Giorgio, D'Amore Antonio, Maremmani Icro, Bernardi Mauro
Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy
Vincent P Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara Hospital, University of Pisa, Pisa, Italy.
J Psychopharmacol. 2016 Apr;30(4):402-9. doi: 10.1177/0269881116629126. Epub 2016 Feb 9.
The treatment of alcohol use disorder still remains a challenge. The efficacy of the combined pharmacological treatment for alcohol use disorder has been widely investigated with controversial results. The aim of our case series was to investigate the effect of nalmefene in patients not responding to sodium oxybate therapy. We describe seven cases of consecutive patients affected by alcohol use disorder, and treated with sodium oxybate (50 mg/kg per day) who did not achieve complete alcohol abstinence after at least one month of pharmacological treatment. Then, in partial- and non-responder patients to sodium oxybate treatment, administration of nalmefene, 18 mg as needed, was commenced. Our data show that, during the first month of the combined treatment of sodium oxybate plus nalmefene, patients were able to achieve alcohol abstinence (two patients), to suppress (five cases) or reduce (two patients) episodes of heavy drinking days, and to suppress the onset of craving for sodium oxybate (one patient). Likely, nalmefene may act in modulating the excessive reward effect of sodium oxybate, which may be responsible for the persistence of alcohol intake and for the onset of craving for sodium oxybate. However, controlled clinical trials to confirm the safety and efficacy of sodium oxybate plus nalmefene in treating alcohol use disorder are warranted.
酒精使用障碍的治疗仍然是一项挑战。针对酒精使用障碍的联合药物治疗的疗效已得到广泛研究，但结果存在争议。我们这个病例系列的目的是研究纳美芬对接受γ-羟基丁酸钠治疗无效的患者的影响。我们描述了7例连续的酒精使用障碍患者，他们接受了γ-羟基丁酸钠（每天50mg/kg）治疗，在至少1个月的药物治疗后仍未实现完全戒酒。然后，对于γ-羟基丁酸钠治疗部分反应不佳和无反应的患者，开始按需给予18mg纳美芬。我们的数据表明，在γ-羟基丁酸钠加纳美芬联合治疗的第一个月期间，患者能够实现戒酒（2例患者）、抑制（5例）或减少（2例患者）重度饮酒天数发作，并抑制对γ-羟基丁酸钠的渴望发作（1例患者）。纳美芬可能通过调节γ-羟基丁酸钠的过度奖赏效应起作用，这可能是导致酒精摄入持续存在以及对γ-羟基丁酸钠产生渴望的原因。然而，有必要进行对照临床试验，以证实γ-羟基丁酸钠加纳美芬治疗酒精使用障碍的安全性和有效性。
