Kranzler Henry R, Hartwell Emily E
Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, Pennsylvania, USA.
Alcohol Clin Exp Res (Hoboken). 2023 Jul;47(7):1224-1237. doi: 10.1111/acer.15118. Epub 2023 Jun 8.
Chronic heavy alcohol use impacts all major neurotransmitter systems and is associated with multiple medical, psychiatric, and social problems. Available evidence-based medications to treat alcohol use disorder (AUD) are underutilized in clinical practice. These medications promote abstinence or reduce alcohol consumption, though there are questions regarding their optimal dosage, length of treatment, and utility in combination with one another. Pharmacogenetic approaches, which use a patient's genetic make-up to inform medication selection, have garnered great interest but have yet to yield results robust enough to incorporate them in routine clinical care. This narrative review summarizes the evidence both for medications approved by the Food and Drug Administration (disulfiram, oral naltrexone, acamprosate, and extended-release naltrexone) and those commonly used off-label (e.g., gabapentin, baclofen, and topiramate) for AUD treatment. We discuss these drugs' mechanisms of action, clinical use, pharmacogenetic findings, and treatment recommendations. We conclude that the most consistent evidence supporting the pharmacotherapy of AUD is for the opioid antagonists, naltrexone and nalmefene (which is not approved in the United States), and topiramate. These medications demonstrate consistent small or moderate effects in reducing the frequency of drinking and/or heavy drinking. Lastly, we make suggestions for research needed to refine and expand the current literature on effective pharmacotherapy for AUD.
长期大量饮酒会影响所有主要神经递质系统，并与多种医学、精神和社会问题相关。用于治疗酒精使用障碍（AUD）的现有循证药物在临床实践中未得到充分利用。这些药物可促进戒酒或减少酒精消费，不过关于其最佳剂量、治疗时长以及相互联合使用的效用仍存在疑问。药物遗传学方法利用患者的基因组成来指导药物选择，已引起极大关注，但尚未产生足够有力的结果以将其纳入常规临床护理。这篇叙述性综述总结了美国食品药品监督管理局批准的药物（双硫仑、口服纳曲酮、阿坎酸和长效纳曲酮）以及常用于非标签用途（如加巴喷丁、巴氯芬和托吡酯）治疗AUD的药物的相关证据。我们讨论了这些药物的作用机制、临床应用、药物遗传学研究结果以及治疗建议。我们得出结论，支持AUD药物治疗的最一致证据是针对阿片类拮抗剂纳曲酮和纳美芬（纳美芬在美国未获批准）以及托吡酯。这些药物在减少饮酒频率和/或重度饮酒方面显示出持续的小或中度效果。最后，我们对完善和扩展当前关于AUD有效药物治疗的文献所需的研究提出建议。
