Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA; Pharmacy Department (119), Durham Veterans Affairs Health Care System, 508 Fulton St., Durham, NC 7705, USA.
Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA; Pharmacy Department (119), Durham Veterans Affairs Health Care System, 508 Fulton St., Durham, NC 7705, USA.
J Subst Abuse Treat. 2019 Dec;107:38-43. doi: 10.1016/j.jsat.2019.10.003. Epub 2019 Oct 20.
Memantine is commonly used for the treatment of moderate-to-severe Alzheimer's disease. Due to its antagonism of the N-methyl-d-aspartate (NMDA) receptor, which has been shown to block rewarding and reinforcing effects of morphine, memantine has been investigated for potential utilization in opioid use disorder (OUD). The objective of this systematic review is to assess the evidence available to determine the safety and efficacy of memantine as treatment for OUD. Pubmed (1946-August 2019) and Embase (1947-August 2019) were queried using the following search terms: opioid-related disorders, opioids, substance withdrawal syndrome, withdrawal syndrome, opiate addiction, opiate, opiate dependence, opiate substitution treatment, managed opioid withdrawal, or drug withdrawal and memantine. After assessing studies appropriate for the objective, one single-blind and five double-blind, placebo-controlled trials were included. Of the included studies, four demonstrated beneficial effects of memantine either as monotherapy or adjunct to methadone or buprenorphine on reducing opioid cravings and methadone dose, increasing retention rates, and improving cognitive performance in patients with OUD. Two studies did not show benefit on patient retention rates with memantine adjunct to naltrexone. Study durations ranged from 3 to 13 weeks, and memantine dosing ranged from 5 to 60 mg/day. Memantine was well tolerated with similar rates of adverse effects between treatment groups. Based on the reviewed literature, memantine appears most beneficial as an adjunctive treatment for OUD when combined with methadone or buprenorphine, but not naltrexone. Larger studies with longer periods of treatment and follow-up are needed to support the use of memantine in the management of OUD.
盐酸美金刚通常用于治疗中重度阿尔茨海默病。由于其对 N-甲基-D-天冬氨酸（NMDA）受体的拮抗作用，已证明其可阻断吗啡的奖赏和强化作用，因此已研究盐酸美金刚在阿片类药物使用障碍（OUD）中的潜在应用。本系统评价的目的是评估现有证据，以确定盐酸美金刚治疗 OUD 的安全性和有效性。使用以下搜索词在 Pubmed（1946 年 8 月 2019 日）和 Embase（1947 年 8 月 2019 日）进行查询：阿片类相关障碍、阿片类药物、物质戒断综合征、戒断综合征、阿片类药物成瘾、阿片类药物、阿片类药物依赖、阿片类药物替代治疗、管理性阿片类药物戒断或药物戒断和盐酸美金刚。在评估符合目标的研究后，纳入了一项单盲和五项双盲、安慰剂对照试验。在纳入的研究中，有四项研究表明，盐酸美金刚无论是作为单一疗法还是作为美沙酮或丁丙诺啡的辅助疗法，都能有益地减少阿片类药物的渴求、减少美沙酮剂量、提高保留率并改善 OUD 患者的认知表现。两项研究显示，盐酸美金刚辅助纳曲酮对患者保留率没有益处。研究持续时间从 3 周到 13 周不等，美金刚的剂量从 5 毫克/天到 60 毫克/天不等。盐酸美金刚耐受性良好，治疗组之间不良反应发生率相似。根据已审查的文献，盐酸美金刚与美沙酮或丁丙诺啡联合使用时对 OUD 最有益，而与纳曲酮联合使用时则不然。需要更大规模的研究，更长的治疗和随访时间，以支持在 OUD 的管理中使用盐酸美金刚。
