Original Investigation

Psychopharmacology

, Volume 184, Issue 1, pp 115-121

First online:

Galantamine: a cholinergic patch in the treatment of alcoholism: a randomized, placebo-controlled trial

  • K. MannAffiliated withDepartment of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg Email author 
  • , K. AckermannAffiliated withDepartment of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg
  • , A. DiehlAffiliated withDepartment of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg
  • , D. EbertAffiliated withDepartment of Psychiatry and Psychotherapy, University of Freiburg
  • , G. MundleAffiliated withOberbergklinik Baden-Württemberg Addiction Research Consortium
  • , H. NakovicsAffiliated withDepartment of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg
  • , T. RekerAffiliated withDirector of Westfälische Klinik Münster, Friedrich-Wilhelm-Weber
  • , G. RichterAffiliated withHospital Angermuende
  • , L. G. SchmidtAffiliated withDepartment of Psychiatry, Johannes Gutenberg-Universität Mainz
    • , M. DriessenAffiliated withCentre of Psychiatry and Psychological Medicine, Gilead Hospital Bethel
    • , K. RettigAffiliated withBureau of Evaluation and Quality Assurance in Medicine
    • , K. OpitzAffiliated with
    • , B. CroissantAffiliated withDepartment of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg

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Abstract

Objectives

The involvement of the central cholinergic system in alcohol abuse behavior is well known. It is possible that the reinforcing effects of ethanol are partially mediated by nicotinic receptors, which modulate neurotransmitter release. It was demonstrated that the application of a cholinesterase inhibitor reduces alcohol consumption in alcohol-preferring rats. This suggests that galantamine (GAL), a cholinesterase inhibitor, could be effective when seeking to prolong abstinence in recently detoxified alcoholics. This study represents the first reported clinical trial of a cholinergic drug in alcohol-relapse prevention.

Patients and methods

We investigated the efficacy and safety of GAL by conducting a 24-week randomized, placebo-controlled, multicentric clinical trial on 149 recently detoxified alcoholics. Survival analyses (Kaplan–Meier) were performed to reveal evidence of prolonged abstinence periods in patients who received GAL.

Results

Our findings did not support our hypothesis. GAL did not extend the time to first severe relapse. However, additional post hoc analyses suggest that relapsed patients treated with GAL consume less ethanol per drinking day than patients treated with placebo.

Conclusions

GAL seems to be ineffective when used in relapse prevention of detoxified alcoholics. It is possible that alcohol needs to be “on board” for GAL to be beneficial. This could explain why our post hoc analysis showed that GAL possibly reduces the alcohol consumption of relapsers. If confirmed, GAL could play a role in the reduction of harmful alcohol use and at-risk consumption.

Keywords

Galantamine Alcohol dependence Harmful use Relapse prevention Cholinergic system