Soyka Michael, Müller Christian A
a Department of Psychiatry and Psychotherapy , Ludwig Maximilian University , Munich , Germany.
b Medical Park Chiemseeblick Fachklinik für Psychosomatik , Bernau , Germany.
Expert Opin Pharmacother. 2017 Aug;18(12):1187-1199. doi: 10.1080/14656566.2017.1349098. Epub 2017 Jul 24.
Only a few medications are available for the treatment of alcohol use disorders (AUDs). Areas covered: This paper discusses approved AUD medications, including the opioid antagonists naltrexone and nalmefene (the latter is licensed for reduction of alcohol consumption only), the putative glutamate receptor antagonist acamprosate and the aldehyde dehydrogenase inhibitor disulfiram. It also covers off-label medications of interest, including topiramate, gabapentin, ondansetron, varenicline, baclofen, sodium oxybate and antidepressants. Clinical implications, benefits and risks of treatment are discussed. Expert opinion: Acamprosate, naltrexone, nalmefene and disulfiram are the only approved 'alcohol-specific' drugs. Acamprosate and naltrexone have been evaluated in numerous clinical trials and represent evidence-based treatments in AUDs. Nalmefene use, however, is controversial. Supervised disulfiram is a second-line treatment approach. Compounds developed and licensed for different neuropsychiatric disorders are potential alternatives. Encouraging results have been reported for topiramate, gabapentin and also varenicline, which might be useful in patients with comorbid nicotine dependence. The GABA (γ-aminobutyric acid)-B receptor agonist baclofen has shown mixed results; it is currently licensed for the treatment of AUDs in France only. Gabapentin may be close to approval in the USA. Further studies of these novel treatment approaches in AUDs are needed.
仅有少数药物可用于治疗酒精使用障碍（AUDs）。涵盖领域：本文讨论了已获批准的治疗AUDs的药物，包括阿片类拮抗剂纳曲酮和纳美芬（后者仅被批准用于减少酒精摄入量）、假定的谷氨酸受体拮抗剂阿坎酸以及乙醛脱氢酶抑制剂双硫仑。还涵盖了一些值得关注的超说明书用药，包括托吡酯、加巴喷丁、昂丹司琼、伐尼克兰、巴氯芬、羟丁酸钠及抗抑郁药。文中讨论了治疗的临床意义、益处和风险。专家观点：阿坎酸、纳曲酮、纳美芬和双硫仑是仅有的已获批准的“酒精特异性”药物。阿坎酸和纳曲酮已在众多临床试验中得到评估，是AUDs的循证治疗药物。然而，纳美芬的使用存在争议。监督下使用双硫仑是一种二线治疗方法。针对不同神经精神疾病研发并获批的化合物是潜在的替代药物。托吡酯、加巴喷丁以及伐尼克兰均已报道了令人鼓舞的结果，这些药物可能对合并尼古丁依赖的患者有用。GABA（γ-氨基丁酸）-B受体激动剂巴氯芬的结果喜忧参半；目前仅在法国被批准用于治疗AUDs。加巴喷丁在美国可能即将获批。需要对这些治疗AUDs的新方法进行进一步研究。
