Farmacoterapia de la deshabituación alcohólica. Nuevos fármacos, nuevos conceptos

Autores/as

  • M. Balcells Unidad de Alcohología de la Generalitat de Cataluña. ICPP. Hospital Clínico de Barcelona.
  • Antoni Gual Unidad de Alcohología de la Generalitat de Cataluña. ICPP. Hospital Clínico de Barcelona. Presidente de Socidrogalcohol. Enviar correspondencia a: Antoni Gual. Unitat d’Alcohologia de la Generalitat. ICPP. Hospital Clínic. Villarroel 170. 08036 Barcelona.

DOI:

https://doi.org/10.20882/adicciones.537

Palabras clave:

Alcohol, dependencia, deshabituación, síndrome de abstinencia, craving, disulfiram, acido γ-hidróxibutírico, naltrexona, acamprosato, nalmefene, bromocriptina, tiapride, flupentixol, ISRS, Buspirona, ondansetron

Resumen

Este capítulo revisa la evidencia existente sobre la efectividad de la farmacoterapia en la deshabituación alcohólica. Los fármacos ensayados actúan sobre diversos neurotransmisores cerebrales: dopamina, serotonina, GABA, ácido glutámico, sistema opioide, etc. Disulfiram, acamprosato y naltrexona son los fármacos más comúnmente usados en la deshabituación. El disulfiram parece ser efectivo especialmente cuando se administra supervisadamente. En el caso de la naltrexona y acamprosato, los mecanismos de acción farmacológicos no han podido establecerse plenamente, aunque existe evidencia de que el acamprosato actúa modulando el sistema NMDA-glutamato, mientras que la naltrexona actúa en el sistema de recompensa a través de los opioides endógenos. Asimismo, no se ha podido establecer cual es el perfil clínico de los pacientes que mejor responden a dichos fármacos. Fármacos que actúan sobre el sistema dopaminérgico (tiapride, bromocriptina, flupentixol), sobre el sistema serotoninérgico (buspirona, ISRS, ondansetron), así como el ácido -hidroxibutírico (GHB), han sido utilizados en ensayos clínicos, sin que la evidencia sea suficiente para aprobar su utilización en la dependencia alcohólica. Finalmente, la investigación realizada con combinaciones de los diversos fármacos citados, no aporta de momento resultados relevantes.

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2002-12-15

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