Amisulpride en el tratamiento de la dependencia alcohólica

  1. Flórez Menéndez, Gerardo
  2. Saiz Martínez, Pilar Alejandra
  3. García Portilla González, María Paz
  4. Álvarez González, Sandra
  5. Nogueiras Fernández, Luis
  6. Bobes García, Julio
Journal:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Year of publication: 2011

Volume: 23

Issue: 2

Pages: 149-156

Type: Article

DOI: 10.20882/ADICCIONES.158 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Adicciones: Revista de socidrogalcohol

Sustainable development goals

Abstract

Objetivos: Estudio abierto, naturalístico de 6 meses de seguimiento, para comparar la eficacia de amisulpride frente a topiramato y naltrexona en pacientes con dependencia al alcohol. Métodos: se han incluido un total de 274 pacientes diagnosticados de dependencia al alcohol y con un consumo intenso de alcohol durante el último mes. Una vez desintoxicados los pacientes fueron asignados a diferentes grupos de tratamiento (naltrexona a 50 mgr por día, topiramato a 200 mgr por día o amisulpride a 100 mgr por día). Dichos pacientes fueron evaluados al inicio del tratamiento y a los 3 y 6 meses de seguimiento mediante instrumentos para medir el consumo de alcohol (EuropASI y Alcohol Timeline Followback), el craving (OCDS), la discapacidad (WHO/DAS) y la calidad de vida (EQ-5D); también se utilizaron marcadores biológicos de consumo de alcohol. Resultados: a los 6 meses los pacientes que tomaban amisulpride obtenían peores resultados en variables relacionadas directamente con el consumo de alcohol (OCDS, alcohol consumido, número de bebidas por día de consumo y días de consumo intenso), sin embargo no se encontraron diferencias significativas en esas variables al compararse con naltrexona. Conclusiones: en este estudio, amisulpride, a dosis de 100 mgr por día, fue menos eficaz que topiramato, a dosis de 200 mgr por día, pero demostró eficacia similar a la naltrexona, a dosis de 50 mgr por día, a la hora de reducir el consumo de alcohol y el craving.

Bibliographic References

  • Koob GF, Roberts AJ, Schulteis G, Parsons LH, Heyser CJ, Hyytia P et al. Neurocircuitry targets in ethanol reward and dependence. Alcohol Clin Exp Res 1998; 22: 3-9.
  • Koob GF, Le Moal M. Neurobiological mechanisms for opponent motivational processes in addiction. Phil Trans Soc B 2008; 363: 3113-23.
  • Srisurapanot M, JarusuraisinN. Naltrexone for the treatment of alcoholism: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol 2005; 8: 267-280.
  • Mason BJ, Ownby RL. Acamprosate for the treatment of alcohol dependence: a review of double – blind, placebo – controlled trials. CNS 2000; 5: 58-69.
  • Hughes JL, Cook CCH. The efficacy of disulfiram: a review of outcome studies. Addiction 1997; 92: 381-96.
  • Johnson BA, Ait-Daoud N, Bowden CL, DiClemente CC, Roache JD, Lawson K et al. Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 2003; 361: 1677-85.
  • Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K et al. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA 2007; 298: 1641-51.
  • Kampman KM, Pettinati HM, Lynch KG, Whittingham T, Macfadden W, Dackis C et al. A double-blind, placebo-controlled pilot trial of quetiapine for the treatment of Type A and Type B alcoholism. J Clin Psychopharmacol 2007; 27: 344-51.
  • Marra D, Warot D, Berlin I, Hispard E, Noticies C, Tilikete S. et al. Amisulpride does not prevent relapse in primary alcohol dependence: results of a pilot randomized, placebo-controlled trial. Alcohol Clin Exp Res 2002; 26: 1545-52.
  • World Health Organization. ICD-10, 10th Revision of the International Classification of Diseases. Madrid: World Health Organization; 1992.
  • Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N et al. (2004) Alcohol use. En: Ezzati M, Lopez AD, Rodgers A, Murray CJL editores. Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors, Vol. 1. Ginebra: Organización Mundial de la Salud; 2004. p. 995-1108.
  • Kokkevi A, Hartgers C. European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. Eur Addict Res 1995;1: 208-10.
  • Sobell LC, Sobell MB. Alcohol timeline followback user’s manual. Toronto: Addiction Research Foundation; 1995.
  • Flórez G. Genética y comportamiento: Respuesta al tratamiento de deshabituación alcohólica en función de variables genéticas. Comunicación presentada a las XXXVI Jornadas Nacionales de Socidrogalcohol. Salamanca, 26, 27 y 28 de marzo de 2009.
  • Chang PH, Steinberg MB. Alcohol withdrawal. Med Clin North Am 2001; 85: 1191-12.
  • Volpicelli JR, Pettinati HM, McLellan AT, McLellan T, O’Brien CHP. Enhanced medication and treatment adherence for addiction treatment: the BRENDA model. New York: The Guilford Press; 2001.
  • Anton RF, Moak DH, Latham P. The obsessive compulsive drinking scale: A self-rated instrument for the quantification of thoughts about alcohol and drinking behavior. Alcoholism Clin Exp Res 1995; 19: 92-9.
  • Fagerström KO. Measuring degrees of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978; 3: 235-41.
  • Loranger AW, Sartorius N, Andreoli P, Berger P, Buchheim P, Channabasavanna SM et al. The international personality disorder examination. Arch Gen Psychiatry 1994; 51: 215-24.
  • Rollnick S, Heather N, Gold R, Hall W. Development of a short ‘readiness to change’ questionnaire for use in brief, opportunistic interventions among excessive drinkers. Br J Addict 1992; 87: 743-54.
  • Janca A, Kastrup M, Katschnig H, López-Ibor JJJr, Mezzich JE, Sartorius N . The World Health Organization Short Disability Assessment Schedule (WHO DAS – S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders. Soc Psychiatr Psychiatr Epidemiol 1996; 31: 349-54.
  • EuroQoL Group. EuroQoL – a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199208.
  • Allen JP, Litten RZ, Strid N, Sillanaukee P. The role of biomarkers in alcoholism medication trials. Alcoholism Clin Exp Res 2001; 25: 1119-25.
  • Lingjaerd O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale. Acta Psychiatr Scand 1987; 76: 1-100.
  • Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67-74.
  • Babor TF, Longabaugh R, Zweben A, Fuller RK, Stout RL, Anton RF et al. Issues in the definition and measurement of drinking outcomes in alcoholism treatment research. J Stud Alcohol 1994; 12: 101-111.
  • Cisler RA, Zweben A. Development of a composite measure for assessing alcohol treatment outcome: operationalization and validation. Alcoholism Clin Exp Res 1999; 23: 263-271.
  • Stout RL. Methodological and statistical considerations in measuring alcohol treatment effects. Alcoholism Clin Exl Res 2003; 27: 1686-1691.
  • Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM et al. COMBINE Study Research Group. Combined pharma cotherapies and behavioral interventions for alcohol dependence – the COMBINE study: a randomized controlled trial. JAMA 2006; 295: 2003-2017.
  • Nutt D. Alcohol and the brain: pharmacological insights for psychiatrists. Br J Psychiatry 1999; 175: 114-19.
  • Koob GF, Le Moal M. Drug abuse: hedonic homeostatic dysregulation. Science 1997; 278: 52-8.
  • Noble EP. Alcoholism and the dopaminergic system. Addict Biol 1996; 1: 333-348.
  • Heinz A, Beck A, Grüsser SM, Grace AA, Wrase J. Identifying the neural circuitry of alcohol craving and relapse vulnerability. Addict Biol 2008; 14: 108-18.
  • Schoemaker H, Claustre Y, Fage D, Rouquier L, Chergui K, Curet O et al. Neurochemical characteristics of amisulpride, an atypical dopamine D2/D3 receptor antagonist with both presynaptic and limbic selectivity. J Pharmacol Exp Ther 1997; 280: 83-97.
  • Hermann D, Smolka MN, Wrase J, Klein S, Nikitopoulos J, Georgi A et al. Blockade of cue-induced brain activation of abstinent alcoholics by a single administration of amisulpride as measured with fMRI. Alcohol Clin Exp Res 2006; 30: 1349-54.