Emerging Pharmacologic Treatments for Alcohol Dependence
J Clin Psychiatry 2006;67(suppl 14):35-40
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Increased understanding of the neurobiology of alcohol dependence has led to studies of pharmacologic
agents that modify drinking behavior. Because alcoholism is a heterogeneous disease involving
multiple neurotransmitter and receptor systems, it is likely that a variety of pharmacologic agents
will be required to have the greatest impact on outcomes across individuals. Several medications have
been approved for the management of alcohol dependence. In addition, several drugs currently used
for other indications have been studied for use in alcohol dependence, and some of these drugs show
promise. For example, selective serotonin reuptake inhibitors have been shown to reduce drinking in
subgroups of alcoholic patients, including those with comorbid depression and those with later-onset
alcohol dependence. Ondansetron, a selective 5-hydroxytryptamine3 receptor antagonist, may attenuate
the urge to drink and thus increase abstinence. The anticonvulsant agent topiramate also has significantly
reduced drinking behavior in early clinical studies. Baclofen, a γ-aminobutyric acid B
agonist, has been shown to decrease drinking in animal models and in 1 small, placebo-controlled trial
in humans. Rimonabant, a cannabinoid CB1 receptor antagonist, has been shown to help nicotine
dependence in humans, and in animal studies, to reduce alcohol consumption; no clinical trials in alcoholism
have been published. Dopamine antagonists, including clozapine and the newer atypical
antipsychotics, may have value in the treatment of alcoholism but require further study. Corticotropin-releasing
factor 1 receptor antagonists and neuropeptide Y1 receptor antagonists have been shown to
reduce drinking behavior in animals but have not undergone clinical trials.