Naltrexone for alcohol dependence

Naltrexone combined with psychosocial treatment is superior to placebo in preventing alcohol relapse and return to drinking.

A Cochrane review included 50 studies with a total of 7793 subjects. Added to psychosocial treatment strategies, naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group (RR 0.83, 95% CI 0.76 to 0.90; 28 trials, n=4433) and decreased drinking days by about 4% ( MD -3.89, 95% CI -5.75 to -2.04; 26 trials, n=3882). It also decreased heavy drinking days (MD - 3.25, 95% CI -5.51 to -0.99; 15 trials, n=1715), consumed amount of alcohol (MD - 10.83, 95% CI -19.69 to -1.97; 16 trials, n=1838) and gamma-glutamyltransferase (MD - 10.37, 95% CI -18.99 to -1.75; 16 trials, n=1645), while effects on return to any drinking (RR 0.96, 95 CI 0.92 to 1.00; 27 trials, n=4693) missed statistical significance. Side effects of naltrexone were mainly gastrointestinal problems e.g. nausea and sedative effects e.g. daytime sleepiness. Based on a limited study sample, effects of injectable naltrexone missed statistical significance.

A systematic review and meta-analysis assessed the efficacy of acamprosate or naltrexone in reducing lapse/relapse compared to placebo in the treatment of alcohol dependence and treatment discontinuation. 22 RCTs studied acamprosate (n=5236) and 27 RCTs naltrexone (n=4199). The risk of returning to any drinking at 6 months was significantly lower for acamprosate (RR 0.83, 95% CI 0.78 to 0.89). There was little difference in the risk of participants discontinuing treatment for any reason (RR  0.91, 95% CI 0.83 to 1.00) or due to adverse events (RR 1.30, 95% CI 0.96 to 1.75) for the acamprosate compared to placebo groups. For natrexone, the risk of individuals returning to any drinking at approximately 3 months was reduced significantly (RR 0.92, 95% CI  0.86 to 1.00), as was the risk of individuals relapsing to heavy drinking at 3 months (RR  0.85, 95% CI  0.78 to 0.93). There was no significant difference between naltrexone and placebo for the risk of individuals discontinuing treatment for any reason (RR  0.94, 95% CI  0.84 to 1.05), but. risk discontinuing treatment due to adverse events was higher (RR  1.72, 95% CI  1.10 to 2.70).

Ədəbiyyat

1. Rösner S, Hackl-Herrwerth A, Leucht S et al. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 2010;(12):CD001867.
2. Donoghue K, Elzerbi C, Saunders R et al. The efficacy of acamprosate and naltrexone in the treatment of alcohol dependence, Europe versus the rest of the world: a meta-analysis. Addiction 2015;110(6):920-30.