Amisulpride en el tratamiento de la dependencia alcohólica
DOI:
https://doi.org/10.20882/adicciones.158Palabras clave:
amisulpride, naltrexona, topiramato, dependencia alcohólica y tratamientoResumen
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.Citas
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: 199-208.
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 pharmacotherapies
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
; 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.