Alcohol dependence (pharmacological management) Flashcards
Disulfiram
Disulfiram blocks the conversion of aldehyde to acetic acid by binding irreversibly to aldehyde dehydrogenase. This leads to an unpleasant build up of aldehyde in the blood and results in symptoms such as abdominal colic, flushing, anxiety, dizziness, tachycardia, vomiting and headache. Symptoms start 5-15 minutes after drinking alcohol and last for several hours producing symptoms of nausea and headache.
If large doses of alcohol are consumed whilst receiving disulfiram treatment, collapse, cardiac arrhythmias and even death can occur. Patients should be warned that the severity of the reaction is unpredictable. Occasionally a reaction may be triggered by the small amount of alcohol in preparations such as cough linctus.
Acamprosate
Acamprosate is a structural analogue of gamma-aminobutyric acid (GABA). It is thought to decrease alcohol intake by affecting calcium channels and modifying transmission along GABA and glutamine pathways in the brain, which may result in decreased positive reinforcement of alcohol intake and decreased withdrawal cravings. Multiple studies have established a good safety profile for acamprosate. There is no potential for abuse or dependence. Overdose is not considered to be fatal, but chronic overdose can result in hypercalcemia. Acamprosate is well tolerated, diarrhea, which is dose-related and usually transient and is the most common side effect. The down regulation of GABA-A that occurs in alcohol dependence is thought to be responsible for the unpleasant withdrawal state seen in when alcohol is discontinued. Acamprosate acts as an agonist at GABA-A to mitigate these withdrawal effects
Naltrexone
Naltrexone hydrochloride is a relatively pure and long-lasting opioid antagonist. Naltrexone reduces both the rewarding effects of alcohol and craving for it. Naltrexone has a low incidence of common adverse events, virtually no abuse potential and patients do not develop tolerance for its efficacy.
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