Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T07:23:19.764Z Has data issue: false hasContentIssue false

Combination Pharmacotherapy in Alcoholism: A Novel Treatment Approach

Published online by Cambridge University Press:  07 November 2014

Abstract

Combination pharmacotherapy has proven effective in a number of psychiatric disorders, including depression and schizophrenia. However, compared with other affective disorders, few studies have explored the use of combination therapy in alcoholism, and the majority have been limited to animal models. There is evidence to support a role for combination therapy in alcoholism. For example, several neurochemical systems, including the dopaminergic, serotonergic, and opioidergic, appear to affect alcohol intake. Studies in several different types of alcohol-preferring rats have suggested that coadministration of agents to target more than one of these systems simultaneously may produce beneficial effects on alcohol intake, while avoiding problematic effects, such as alterations in food or water intake. Data from preliminary clinical studies have shown trends toward combination therapy reducing alcohol intake in humans. While such findings are encouraging, they must be explored further in larger, randomized, double-blind trials.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Stein, G, Bernadt, M. Lithium augmentation therapy in tricyclic-resistant depression: a controlled trial using lithium in low and normal doses. Br J Psychiatry. 1993;162:634640.CrossRefGoogle ScholarPubMed
2.Zusky, PM, Biederman, J, Rosenbaum, JF, et al.Adjunct low dose lithium carbonate in treatment-resistant depression: a placebo-controlled study. J Clin Psychopharmacol. 1986;8:120124.Google Scholar
3.Schopf, J, Baumann, P, Lemarchand, T, Rey, M. Treatment of endogenous depressions resistant to tricyclic antidepressants or related drugs by lithium addition: results of a placebo-controlled double-blind study. Pharmacopsychiatry. 1989;22:183187.CrossRefGoogle ScholarPubMed
4.Thase, ME, Rush, AJ. Treatment-resistant depression. In: Bloom, FK, Kupfer, DJ, eds. Psychopharmacology: The Fourth Generation of Progress. Baltimore, MD: Raven Press Ltd; 1995:10811097.Google Scholar
5.Ketter, TA, Post, RM, Parekh, PI, Worthington, K. Addition of monoamine oxidase inhibitors to carbamazepine: preliminary evidence of safety and antidepressant efficacy in treatment-resistant depression. J Clin Psychiatry. 1995;56:471475.Google ScholarPubMed
6.Artigas, F, Perez, V, Alvarez, E. Pindolol induces a rapid improvement of depressed patients treated with serotonin reuptake inhibitors. Arch Gen Psychiatry. 1994;51:248251.CrossRefGoogle ScholarPubMed
7.Wolkowitz, OM. Rational polypharmacy in schizophrenia. Ann Clin Psychiatry. 1993;5:7990.CrossRefGoogle ScholarPubMed
8.Kane, J, Honigfeld, G, Singer, J, Meltzer, H. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988;45:789796.CrossRefGoogle ScholarPubMed
9.Tollefson, GD, Beasley, CM Jr, Tran, PV, et al.Olanzapine vs haloperidol in the treatment of schizophrenia and schizoaffective and schizo-phreniform disorders: results of an international collaborative trial. Am J Psychiatry. 1997;154:457465.Google Scholar
10.Fuller, RK, Branchey, L, Brightwell, DR, et al.Disulfiram treatment of alcoholism: a Veterans Administration cooperative study. JAMA. 1986;256:14491455.CrossRefGoogle ScholarPubMed
11.Swift, R. Opioid antagonists and alcoholism treatment. CNS Spectrums. 2000;5(2):xxxx.CrossRefGoogle ScholarPubMed
12.Pettinati, HJ, Oslin, D, Decker, K. Role of serotonin and serotonin-selective pharmacotherapy in alcohol dependence. CNS Spectrums. 2000;5(2):xxxx.CrossRefGoogle ScholarPubMed
13.Mason, B. Acamprosate for the treatment of alcohol dependence: a review of double-blind, placebo-controlled trials. CNS Spectrums. 2000;5(2):xxxx.CrossRefGoogle ScholarPubMed
14.McBride, WJ, Murphy, JM, Lumeng, L, Li, T-K. Serotonin, dopamine and GABA involvement in alcohol drinking of selectively bred rats. Alcohol. 1990;7:199205.CrossRefGoogle ScholarPubMed
15.Sellers, EM, Higgins, GA, Sobell, MB. 5-HT and alcohol abuse. Trends Pharmacol Sci. 1992;13:6975.CrossRefGoogle ScholarPubMed
16.Rezvani, AH, Overstreet, DH, Janowsky, DS. Genetic serotonin deficiency and alcohol preference in the Fawn-Hooded rats. Alcohol Alcohol. 1990;25:573575.Google ScholarPubMed
17.Rezvani, AH, Grady, DR. Suppression of alcohol consumption by fenfluramine in Fawn-Hooded rats with serotonin dysfunction. Pharmacol Biochem Behav. 1994;48:105110.CrossRefGoogle ScholarPubMed
18.Koob, GF, Rassnick, S, Heinrichs, S, Weiss, F. Alcohol, the reward system and dependence. EXS. 1994;71:103114.Google ScholarPubMed
19.Froehlich, JC, Harts, J, Lumeng, L, Li, T-K. Naloxone attenuates voluntary ethanol intake in rats selectively bred for high ethanol preference. Pharmacol Biochem Behav. 1990;35:385390.CrossRefGoogle ScholarPubMed
20.Reid, LD. Endogenous opioids and alcohol dependence: opioid alkaloids and propensity to drink alcohol beverages. Alcohol. 1996;13:511.CrossRefGoogle Scholar
21.Hjorth, S, Westlin, D, Bengtsson, HJ. WAY100635-induced augmentation of the 5-HT-elevating action of citalopram: relative importance of the dose of the 5-HT1A (auto) receptor blocker vs that of the 5-HT reuptake inhibitor. Neuropharmacology. 1997;36:461465.CrossRefGoogle Scholar
22.Zhou, FC, McKinzie, DL, Patel, TD, Lumeng, L, Li, T-K. Additive reduction of alcohol drinking by 5-HT1A antagonist WAY 100635 and serotonin uptake blocker fluoxetine in alcohol-preferring P rats. Alcohol Clin Exp Res. 1998;22:266269.CrossRefGoogle ScholarPubMed
23.Le, AD, Sellers, EM. Interaction between opiate and 5-HT3 receptor antagonists in the regulation of alcohol intake. Alcohol Alcohol Suppl. 1994;2:545549.Google ScholarPubMed
24.Benjamin, D, Grant, ER, Pohorecky, LA. Naltrexone reverses ethanol-induced dopamine release in the nucleus accumbens in awake, freely moving rats. Brain Res. 1993;621:137140.CrossRefGoogle ScholarPubMed
25.Wozniak, KM, Pert, A, Linnoila, M. Antagonism of 5-HT3 receptors attenuates the effects of ethanol on extracellular dopamine. Eur J Pharmacol. 1990;187:287289.CrossRefGoogle ScholarPubMed
26.O'Malley, SS, Jaffe, AJ, Chang, G, Schottenfeld, RS, Meyer, RE, Rounsaville, B. Naltrexone and coping skills therapy for alcohol dependence. Arch Gen Psychiatry. 1992;49:475481.CrossRefGoogle ScholarPubMed
27.Sellers, EM, Toneatto, T, Romach, MK, Somer, GR, Sobell, L, Sobell, MB. Clinical efficacy of the 5-HT3 antagonist ondansetron in alcohol abuse and dependence. Alcohol Clin Exp Res. 1994;18:879885.CrossRefGoogle ScholarPubMed
28.Rezvani, AH, Pucilowski, O, Grady, DR, Janowsky, D, O'Brien, RA. Reduction of spontaneous alcohol drinking and physical withdrawal by levemopamil, a novel Ca channel antagonist, in rats. Pharmacol Biochem Behav. 1993;46:365371.CrossRefGoogle Scholar
29.Pucilowski, O, Rezvani, AH, Janowsky, DS. Suppression of alcohol and saccharin preference in rats by a novel Ca channel inhibitor, Goe 5438. Psychopharmacology (Berl). 1992;107:447452.CrossRefGoogle Scholar
30.Gardell, LR, Whalen, CA, Chattophadyay, S, Cavallaro, CA, Hubbell, CL, Reid, LD. Combination of naltrexone and fluoxetine on rats' propensity to take alcoholic beverage. Alcohol Clin Exp Res. 1997;21:14351439.Google ScholarPubMed
31.Zink, RW, Rohrbach, K, Froehlich, JC. Naltrexone and fluoxetine act synergistically to decrease alcohol intake. Alcohol Clin Exp Res. 1997;21(suppl):104A.Google Scholar
32.Rezvani, AH, Overstreet, DH, Mason, GA. Combination pharmacotherapy: a new concept for the treatment of alcoholism. Alcohol Clin Exp Res. 1998;22(suppl):142A.Google Scholar
33.Mason, GA, Rezvani, AH, Overstreet, DH, Garbutt, JC. thyrotropin releasing hormone analog TA-0910 reduces voluntary alcohol intake of P rats subchronically in a limited scheduled access paradigm. Alcohol Clin Exp Res. 1996;20:10001003.CrossRefGoogle Scholar
34.Rezvani, AH, Garbutt, JC, Shimoda, K, Garges, PL, Janowsky, DS, Mason, GA. Attenuation of alcohol preference in alcohol-preferring rats by a novel TRH analogue, TA-0910. Alcohol Clin Exp Res. 1992;16:326330.CrossRefGoogle ScholarPubMed
35.Di Chiara, G, Imperato, A. Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Proc Natl Acad Sci USA. 1988;85:52745278.CrossRefGoogle ScholarPubMed
36.Hodge, CA, Haraguchi, M, Erickson, HL, Samson, HH. Ventral tegmental microinjections of quinpirole decrease ethanol and sucrose-reinforced responding. Alcohol Clin Exp Res. 1993;17:370375.CrossRefGoogle ScholarPubMed
37.Wise, RA, Bozarth, MA. Action of drugs of abuse on brain reward systems: an update with specific attention to opiates. Pharmacol Biochem Behav. 1982;17:239243.CrossRefGoogle ScholarPubMed
38.Weiss, F, Lorang, MT, Bloom, FE, Koob, GF. Oral alcohol self-administration stimulates dopamine release in the rat nucleus accumbens: genetic and motivational determinants. J Pharmacol Exp Ther. 1993;267:250258.Google ScholarPubMed
39.Farren, CK, Catapano, D, O'Malley, S. Sertraline with naltrexone vs naltrexone alone in the treatment of alcohol dependence. Alcohol Clin Exp Res. 1997;21(suppl):64A.Google Scholar
40.Anton, RF, Moak, DH, Latham, PK. The obsessive-compulsive drinking scale: a new method of assessing outcome in alcoholism treatment studies. Arch Gen Psychiatry. 1996;53:225231.CrossRefGoogle Scholar
41.Beck, AT, Ward, CH, Mendelson, M. An inventory for measuring depression. Arch Gen Psychiatry. 1961;3:461471.Google Scholar
42.Williams, LD, Mason, BJ. Combination pharmacotherapy in nalmafene non responders. Alcohol Clin Exp Res. 1997;21(suppl):33A.Google Scholar
43.Besson, J, Aeby, F, Kasas, A, Lehert, P, Potgieter, A. Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: a controlled study. Alcohol Clin Exp Res. 1998;22:573579.CrossRefGoogle ScholarPubMed