Pharmakologische Therapieoptionen zur Prävention des Alkoholrückfalls

Zusammenfassung

Die Intensität des Suchtdrucks (Craving) wird maßgeblich mit dem Rückfallrisiko der Alkoholabhängigkeit in Zusammenhang gebracht. Es wird angenommen, dass zumindest 3 Gruppen des Craving unterscheidbar sind, denen auf neuronaler Ebene Veränderungen in unterschiedlichen Neurotransmittersystemen zugrunde liegen. Momentan sind in Deutschland die Substanzen Acamprosat und Disulfiram zur Rückfallprophylaxe der Alkoholabhängigkeit zugelassen. Im Rahmen von Therapieversuchen ist auch eine Anwendung von Naltrexon möglich. Aktuelle Studienergebnisse zeigen jedoch, dass diese Substanzen nicht bei allen Patienten gleichermaßen wirksam sind. Substanzen, die spezifisch auf die zugrunde liegenden Neurotransmitterveränderungen wirken, könnten hypothetisch die Wirksamkeit der medikamentösen Alkoholrückfallprophylaxe bei bestimmten Personengruppen erhöhen. Deswegen werden aktuell weitere Substanzgruppen auf eine mögliche Wirksamkeit in der Alkoholrückfallprophylaxe untersucht. Substanzen, die in präklinischen oder ersten klinischen Studien Wirksamkeit in der Alkoholrückfallprävention gezeigt haben, sind Baclofen, Topiramat, Odansetron, Rimonabant und Memantin.

Abstract

Many studies address the neurobiological mechanisms of alcohol craving. The study results obtained so far show that there may be at least three subtypes of craving, which may be linked to changes in different neurotransmitter systems. Actually in Germany acamprosate and disulfiram are approved for clinical use for the prevention of alcohol relapse. Also off-label therapy with naltrexone is possible. However studies show that these substances are not effective in all patients. In the light of hypothetical changes in different neurotransmitter systems, subtype specific therapy may be necessary for successful prevention of alcohol relapse. Therefore new therapy options are needed in order to treat alcohol dependent persons. Substances that seem to have efficacy in preclinical or preliminary clinical studies are baclofen, topiramate, odansetron, rimonabant and memantine.

Schlüsselwörter

Alkoholabhängigkeit - Alkoholentzug - Rückfallprävention - Craving - Pharmakotherapie

Key words

alcohol addiction - alcohol withdrawal - craving - relapse prevention - pharmacotherapy

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