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Rückfallprävention bei Alkoholabhängigkeit: Acamprosat und Naltrexon als kombinierte pharmakologische Strategie

Relapse prevention in alcohol dependence: acamprosate and naltrexone as a combined pharmacological strategy

Der Nervenarzt volume 84, pages 584–589 (2013)Cite this article

Zusammenfassung

Acamprosat und Naltrexon sind etablierte Strategien zur pharmakologischen Rückfallprophylaxe bei Patienten mit Alkoholabhängigkeit. Obwohl die Kombination beider Substanzen bei dieser Indikation aufgrund pharmakodynamischer und -kinetischer Überlegungen ebenfalls eine sinnvolle Therapieoption darstellt, welche bereits in klinischen Studien als effektiv und sicher beschrieben wurde, wird sie im klinischen Alltag selten eingesetzt. Wir berichten zum einen über eine erfolgreiche Behandlung von Acamprosat und Naltrexon bei einer Patientin mit einer schweren Alkohol- und Benzodiazepinabhängigkeit, welche unter dieser Therapie das längste Abstinenzintervall seit der Entwicklung ihrer Suchterkrankung erreichen konnte. Zudem wird die gegenwärtig verfügbare Evidenz zur Wirksamkeit, Sicherheit und Verträglichkeit der beiden Substanzen in Kombination dargestellt. Die kombinierte Behandlung mit beiden Substanzen sollte bei Patienten, bei welchen unter der Monotherapie keine Abstinenz erzielt werden konnte, bei Fehlen von Kontraindikationen erwogen werden.

Summary

Acamprosate and naltrexone are established strategies for pharmacologic relapse prevention in patients with alcohol dependence. Regarding pharmacodynamic and pharmacokinetic considerations the combination of both agents for this indication is a reasonable treatment option that has been described to be safe and effective in clinical studies. However, this combination is uncommon in clinical practice. We report the case of a patient with severe alcohol and benzodiazepine dependence who achieved the longest interval of abstinence under combined treatment with acamprosate and naltrexone since the development of addiction. In addition, the currently available evidence regarding efficacy, safety and tolerability of both agents is discussed. In summary the combined treatment with both agents should be considered in patients who did not achieve abstinence under monotherapy unless contraindications are present.

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  1. Abteilung für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm, Leimgrubenweg 12–14, 89075, Ulm, Deutschland

    M. Gahr, M.A. Kölle & C. Schönfeldt-Lecuona

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  1. M. Gahr
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  2. M.A. Kölle
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  3. C. Schönfeldt-Lecuona
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Correspondence to M. Gahr.

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Gahr, M., Kölle, M. & Schönfeldt-Lecuona, C. Rückfallprävention bei Alkoholabhängigkeit: Acamprosat und Naltrexon als kombinierte pharmakologische Strategie. Nervenarzt 84, 584–589 (2013). https://doi.org/10.1007/s00115-012-3633-3

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  • DOI: https://doi.org/10.1007/s00115-012-3633-3

Schlüsselwörter

  • Abhängigkeit
  • Abstinenz
  • Craving
  • Rückfallprophylaxe
  • Sucht

Keywords

  • Addiction
  • Abstinence
  • Craving
  • Dependence
  • Relapse prevention