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)

Alcohol dependence: analysis of factors associated with retention of patients in outpatient treatment.

AIMS: To identify factors associated with retention in treatment of alcohol-dependent individuals and to compare treatment retention between men and women. METHODS: Analysis of the treatment attendance records and baseline characteristics of 833 men and 218 women who undertook to attend follow-up treatment in an alcoholism treatment centre. RESULTS: Retention after 4 weeks of treatment is more likely to occur among those using adjuvant medication (the most frequent of which was disulfiram), those presenting severe alcoholism and those who are older and tend to be frequent drinkers. There was no gender difference regarding treatment retention. CONCLUSION: Such results suggest possibilities for developing specific strategies to reduce the risk of early dropout from treatment.

Glutamatergic dysfunction in schizophrenia: from basic neuroscience to clinical psychopharmacology.

The underlying cellular mechanisms leading to frontal cortical hypofunction (i.e., hypofrontality) in schizophrenia remain unclear. Both hypoactive and hyperreactive prefrontal cortical (PFC) states have been reported in schizophrenia patients. Recent proton magnetic resonance spectroscopy studies revealed that antipsychotic-naïve patients with first psychotic episode exhibit a hyperactive PFC. Conversely, PFC activity seems to be diminished in patients chronically exposed to conventional antipsychotic treatments, an effect that could reflect the therapeutic action as well as some of the impairing side effects induced by long-term blockade of dopamine transmission. In this review, we will provide an evolving picture of the pathophysiology of schizophrenia moving from dopamine to a more glutamatergic-centered hypothesis. We will discuss how alternative antipsychotic strategies may emerge by using drugs that reduce excessive glutamatergic response without altering the balance of synaptic and extrasynaptic normal glutamatergic neurotransmission. Preclinical studies indicate that acamprosate, a FDA approved drug for relapse prevention in detoxified alcoholic patients, reduces the glutamatergic hyperactivity triggered by ethanol withdrawal without depressing normal glutamatergic transmission. Whether this effect is mediated by a direct modulation of NMDA receptors or by antagonism of metabotropic glutamate receptor remains to be determined. We hypothesize that drugs with similar pharmacological actions to acamprosate may provide a better and safer approach to reverse psychotic symptoms and cognitive deficits without altering the balance of excitation and inhibition of the corticolimbic dopamine-PFC system. It is predicted that schizophrenia patients treated with acamprosate-like compounds will not exhibit progressive cortical atrophy associated with the anti-dopaminergic effect of classical antipsychotic exposure.

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

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.

Treatment of tinnitus with acamprosate.

Acamprosate, a drug used to treat alcohol dependence, was first reported as a potential treatment for tinnitus in 2005. The drug may improve tinnitus by a dual mechanism of action, acting both as a glutamate antagonist and as a GABA agonist. It is suggested that its action may be both on the ear and the nervous system.

Tinnitus treatment with acamprosate: double-blind study.

UNLABELLED: Nowadays, the treatment of tinnitus is still a great challenge for the otolaryngologists. Many facts remain unknown in its pathophysiology, leading to many different therapies, with irregular results. Acamprosate is a drug used in alcoholism treatment, due to its regulating effects in glutamatergic and GABA neurotransmission, and has never been used before in the treatment of tinnitus AIM: To evaluate efficacy and safety of the acamprosate in the treatment of sensorineural tinnitus. STUDY DESIGN: Randomized clinical trial. MATERIAL AND METHOD: 50 patients with sensorineural tinnitus were divided into two groups: 25 received acamprosate and 25 placebo, for a period of 3 months, in a prospective double-blind study, being analyzed for its efficacy and safety by the subjective score from 1 to 10 given by the patient. RESULTS: We found a high index of success in the relief of tinnitus, about 86.9%. In 47.8% of the cases we found more than 50% relief. The incidence of side effects was low, 12%, all of them mild. CONCLUSION: Acamprosate, a drug used in the treatment of alcoholism, is a safe and successful alternative for sensorineural tinnitus' treatment.

Acamprosate in alcohol dependence: a randomized controlled efficacy study in a standard clinical setting.

OBJECTIVE: This study was undertaken to evaluate the efficacy and safety of acamprosate in the treatment of alcohol dependence. METHOD: The investigation was a double-blind, placebo-controlled, 24-week study carried out at the University of São Paulo, Brazil. The sample comprised 75 patients, 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. After a 1-week detoxification period the patients were randomly divided into two groups: the first received acamprosate (1.998 mg/day) and the second received placebo. After the first 12 weeks, the patients continued follow-up for a similar length of time without medication. The main outcome measures were relapse rates, side effects and time to first relapse. RESULTS: On an intention-to-treat basis, the Kaplan-Meier survival curve showed an advantage in relapse rates for acamprosate over placebo (log-rank test, p = .02), and acamprosate was well tolerated. CONCLUSIONS: Acamprosate seems to be an effective treatment for alcohol dependence in a Brazilian population.

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

The pharmacological intervention can play a crucial role in the reduction of craving and drinking and the maintenance of abstinence. This article reviews pharmacotherapy for alcohol dependence with an emphasis on the naltrexone, dissulfiram and acamprosate. The opioid antagonist naltrexone lowers relapse rate, reduces drinking days and prolongs periods of abstinence. Acamprosate restores the normal activity of glutamate and GABA systems. Disulfiram has been shown to be most effective for patients who believe in its efficacy and remain compliant with the treatment. Ondansetron, has shown promise in the early-onset alcohol dependence but needs more extensive study. Topiramate (up to 300 mg per day) was more efficacious than placebo in the treatment of alcohol dependence.

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% 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.

Acamprosate decreases the induction of tolerance and physical dependence in morphine-treated mice.

The effects of acamprosate, a drug thought to interact with N-methyl-D-aspartate (NMDA) receptors in the central nervous system (CNS), were examined on the antinociceptive action of morphine, induction of tolerance to and physical dependence on morphine, and expression of the abstinence syndrome to the opiate in mice. For the induction of tolerance and dependence, morphine (300 mg/kg) was administered by means of a slow-release preparation. Single doses of acamprosate (50, 100, 200, or 400 mg/kg) administered 30 min before a test dose of morphine did not change the antinociceptive effects of morphine in drug-naive mice. The drug was also administered in repeated doses (50, 100, 200, or 400 mg/kg, 30 min before and 12 and 24 h after the priming dose of morphine) in order to evaluate its effects on the induction of tolerance; all doses assayed, except the 400 mg/kg, did not affect the intensity of tolerance. The acute administration of acamprosate (50, 100, 200, or 400 mg/kg, injected 30 min before naloxone to morphine-pretreated mice) did not affect the intensity of the abstinence behavior. However, the repeated administration of 100 mg/kg of acamprosate (30 min before and 12 and 24 h after the priming dose of morphine) decreased the intensity of physical dependence. The results of these studies suggest that acamprosate may have modulatory effects on glutamatergic neurotransmission participating in the adaptive mechanisms induced by chronic morphine treatment.