Evolución de pacientes con adicción al alcohol con el uso de acamprosato / Progression of patients with alcohol dependence using acamprosate

Introducción: los efectos del consumo excesivo de bebidas alcohólicas para el individuo, la familia y la sociedad son un problema de salud, convertido en la más trascendente toxicomanía en la actualidad. En el mercado existen tres fármacos que reducen el deseo de beber y son el disulfiram, la naltrexona y el acamprosato. El acamprosato es el medicamento que se propone estudiar, ya que en Cuba no existen referencias anteriores de estudios de la efectividad del acamprosato. Objetivo: valorar la evolución del alcoholismo y su tratamiento con acamprosato. Métodos: se diseñó un Estudio de Utilización de Medicamentos observacional y descriptivo, basado en las consecuencias prácticas del uso del acamprosato en pacientes diagnosticados con adicción al alcohol, con una dosis de dos cápsulas de 33,3 mg diarias por vía oral, durante seis meses de tratamiento, desde septiembre de 2012 a febrero de 2013. Resultados: de 44 pacientes evaluados, el 90,9 por ciento no tuvo recaídas, solamente el 9,1 por ciento de los pacientes tuvo deseos de consumir alcohol al inicio del tratamiento. Un paciente mostró intranquilidad como efecto adverso al acamprosato. La autovaloración de todos los pacientes fue positiva, refiriendo en su totalidad que cambiaron para una persona mejor. El 68,2 por ciento de los pacientes tuvieron una evolución excelente, lo que coincide con otros estudios internacionales con el acamprosato. Conclusiones: el tratamiento con acamprosato es efectivo para la prevención de las recaídas y la reducción del consumo de alcohol en el alcoholismo(AU)

Introduction: the effects of the excessive intake of alcohol beverages for the individual, the family and the society represent a health problem turned into the most transcendental toxicomania at present times. There are three drugs on the market which reduce the desire of drinking and are called disulfiram, naltrexone and acamprosate. The latter is the drug to be studied since there are no previous references in Cuba about effectiveness study of acamprosate. Objective: to assess the progression of alcoholism and its treatment with acamprosate. Methods: adescriptive and observational Study of Drug Use was designed on the basis of the practical consequences of the use of acamprosate in patients diagnosed with alcohol dependence, at a dose of two caplets of 33.3mg to be taken daily for six months from September 2012 to February 2013. Results: of 44 evaluated patients, 90.9 percent had no relapses, just 9.1 percent felt the desire of taking alcohol beverages at the onset of treatment. One patient showed restlessness as adverse effect of the drug. The self-assessment of all the patients was positive, stating that they changed into a better person after treatment. In the group, 68.2 percent had an excellent progress which agrees with other international study on this drug. Conclusions: the treatment with acamprosate is effective for the prevention of relapses and the reduction of alcohol dependence(AU)

Surreptitious use of disulfiram.

Disulfiram is one of the most important drugs used in the management of alcohol use disorders . It is of significance as a treatment modality especially in low and middle income countries like India, as it is a cheaper pharmacological option compared to other medications like naltrexone and acamprosate.

The Current Situation of Treatment Systems for Alcoholism in Korea

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.

Actualización del tratamiento farmacológico de la dependencia alcohólica / Pharmacological review of alcoholic dependence treatment

El objetivo de la presente actualización farmacológica es abordar la problemática de la dependencia alcohólica. Partiendo de las bases biológicas y del impacto del etanol sobre los sistemas neurobiológicos y de neurotransmisión, se hará una revisión de las principales herramientas farmacológicas para el tratamiento de la dependencia alcohólica. El disulfiram, la naltrexona y el acamprosato, todas ellas con aprobación por la FDA (Food and Drug Administration) han mostrado mecanismos de acción, perfiles de eficacia, tolerabilidad y adherencia dispares. También nos referiremos al topiramato, el que está siendo estudiado actualmente con relación a esta indicación.

The aim of the present pharmacological update is to revise the problem of alcohol dependence. Starting from the biological bases and the impact of alcohol on the neurobiological and neurotransmission systems, a revision of the main pharmacological tools for alcohol dependence treatment will be done. Disulfiram, naltrexone, acamprosate, all of them approved by the FDA (Food and Drug Administration), have shown mechanisms of action, efficacy, tolerance and adherence dissimilar. We will also refer to topiramate, which is being studied for this indication.

Tratamiento del tinnitus en hipoacusias neurosensoriales de curvas descendentes por modulación de los neurotransmisores con el uso de acamprosato: experiencia clínica / Tinnitus treatment by neurotransmitter modulation in high frequency sensorineural hearing loss using Acamprosate: a clinical experience

Introducción: El tinnitus neurosensorial está correlacionado con numerosas patologías del oído interno y de su vía central y que pueden originarse en cualquier nivel de ésta; sin embargo todas estas noxas pueden manifestarse igual en corteza auditiva, como una sensación auditiva sin mediar un estímulo acústico externo, de tal manera que este mensajero común deben ser los neurotransmisores. Se han descrito dos en la vía auditiva aferente: el glutamato que es excitatorio y el GABA que es inhibitorio. Numerosos estudios revelan que el tinnitus neurosensorial se produciría por un desbalance de estos dos neurotransmisores con predominio excitatorio. El acamprosato es un fármaco usado en el alcoholismo que actuaría modulando el equilibrio GABA-glutamato. Existe un sólo estudio publicado con el uso del acamprosato en el tinnitus con una mejoría o disminución de su intensidad en 80 por ciento o más de los casos. Objetivos: Conocer la real utilidad del fármaco pues en este estudio, arriba mencionado, la evaluación fue sólo subjetiva y sin seguimiento. Material y Método: Fueron estudiados 20 pacientes tratados por un mes efectuándose tinnitumetría, evaluación psicoemocional (THI) y seguimiento. Resultados: De los 20 pacientes, en dos desapareció el tinnitus, en seis bajaron los niveles de la tinnitumetría en 5 dBo más con mejoría del THI en 50 por ciento o más y en doce pacientes la mejoría fue menor o ninguna. Conclusiones: Sería posible modular los neurotransmisores de la vía auditiva aferente con éxito, en aquellos pacientes con tinnitus severo. Es un estudio original con un respaldo fisiopatológico que abre nuevas perspectivas terapéuticas.

Pharmacotherapy for Alcohol Dependence: Anticraving Medications for Relapse Prevention

Alcohol dependence is a chronic disorder that results from a variety of genetic, psychosocial, and environmental factors. Relapse prevention for alcohol dependence has traditionally involved psychosocial and psychotherapeutic interventions. Pharmacotherapy, however, in conjunction with behavioral therapy, is generating interest as another modality to prevent relapse and enhance abstinence. Naltrexone and acamprosate are at the forefront of the currently available pharmacological options. Naltrexone is an opioid receptor antagonist and is thought to reduce the rewarding effect of alcohol. Acamprosate normalizes the dysregulation of N-methyl-D-aspartate (NMDA)-mediated glutamatergic excitation that occurs in alcohol withdrawal and early abstinence.These different mechanisms of action and different target neurotransmitter systems may endow the two drugs with efficacy for different aspects of alcohol use behavior. Since not all patients seem to benefit from naltrexone and acamprosate, there are ongoing efforts to improve the treatment outcomes by examining the advantages of combined pharmacotherapy and exploring the variables that might predict the response of the medications. In addition, novel medications are being investigated to assess their efficacy in preventing relapse and increasing abstinence.

Uso do acamprosato no tratamento do zumbido: um estudo duplo-cego / Tinnitus treatment with acamprosate: double-blind study

O tratamento do zumbido é, ainda nos dias de hoje, um grande desafio para os otorrinolaringologistas. Várias lacunas persistem em sua fisiopatologia, tendo como resultado vários tipos de tratamento, com resultados muito irregulares. O acamprosato é uma droga utilizada no tratamento do alcoolismo, devido à sua ação reguladora da transmissão glutamatérgica e GABA-érgica, nunca tendo sido empregado no tratamento do zumbido. OBJETIVO: Avaliar a segurança e eficácia do uso do acamprosato, no tratamento do zumbido de causa neurossensorial. FORMA DE ESTUDO: ensaio clinico randomizado. MATERIAL E MÉTODO: 50 pacientes com zumbido de causa neurossensorial foram divididos em 2 grupos, 25 recebendo acamprosato e 25 placebo por 3 meses, em um estudo prospectivo duplo-cego, sendo analisados os efeitos terapêuticos e efeitos colaterais, de acordo com escala (nota) de 1 a 10, atribuída pelo próprio paciente. RESULTADOS: Foi observado algum grau de melhora sintomatológica em 86,9 por cento dos pacientes, sendo que em 47,8 por cento dos casos observamos melhora superior a 50 por cento, dados estatisticamente significativos em relação ao placebo. A incidência de efeitos colaterais encontrada foi baixa (12 por cento) e de intensidade leve, com boa tolerabilidade geral. CONCLUSÃO: O acamprosato, medicação utilizada no tratamento do alcoolismo, é eficaz e seguro para o tratamento do zumbido de causa neurossensorial, com percentual de melhora superior à maioria das medicações utilizadas para o tratamento do zumbido, constituindo uma excelente alternativa terapêutica.

Tratamento farmacológico da dependência do álcool / The pharmacologic treatment of the alcohol dependence

As intervencões farmacológicas podem ter um papel crucial na reducão do craving, consumo de álcool e manutencão da abstinência. Este artigo revisa a farmacoterapia para a dependência de álcool com ênfase na naltrexona, dissulfiram e acamprosato. O antagonista opióide naltrexona diminui taxas de recaída, reduz dias de consumo e prolonga períodos de abstinência. Acamprosato restaura a atividade normal dos sistemas glutamato e GABA. Dissulfiram tem demonstrado ser mais efetivo para pacientes que acreditam em sua eficácia e permanecam aderentes ao tratamento. Ondansetron tem-se mostrado promissor na dependência de álcool de início precoce, mas necessita estudos mais extensivos. Topiramato (até 300 mg/dia) foi mais eficaz do que placebo no tratamento da dependência de álcool.

Efficacy of acamprosate in the treatment of alcohol-dependent outpatients

OBJECTIVE: To evaluate the efficacy and security of acamprosate in the treatment of 75 men, aged 18 to 59 years, with diagnosis of alcohol dependence according to the ICD-10. METHODS: Double-blind, placebo-controlled study, 24-week long. After a one-week detoxification period, patients were randomly divided in two groups: the first group received acamprosate (six tablets of 333 mg/d for 12 weeks) and the second group received placebo (six tablets for 12 weeks). After the first 12 weeks, patients continued the follow-up for further 12 weeks without medication. RESULTS: Patients who were receiving acamprosate showed significantly higher continuous abstinence time within the 24 weeks of treatment compared with patients who were assigned to placebo treatment (p=.017). Twenty-five percent of patients who were receiving acamprosate and 20 percent of the placebo-treated patients dropped out. Few side-effects were reported in both groups. CONCLUSION: Acamprosate proved to be safe and effective in treating alcohol-dependent patients and to maintain the abstinence during 24 weeks