Physicians Reluctant to Prescribe for Alcoholism
Other drugs may be on the horizon as well, said Dr. Kranzler, who disclosed that he has received research support and consulting fees from Ortho-McNeil Pharmaceutical, Bristol-Myers Squibb, Forest Pharmaceuticals, and DrugAbuse Sciences Inc.—all of which are involved in manufacturing and/or developing medications for alcohol-dependence treatment.
Phase III trials are underway to test the efficacy of the anticonvulsant topiramate (Topamax) for treating alcohol dependence. An antipsychotic medication, aripiprazole (Abilify), is also being studied in a multicenter trial.
Dr. Kranzler termed both agents “promising,” although their use in clinical practice may be several years away.
Ups and Downs Of Alcohol Drugs
Pharmacology for alcohol treatment has followed a somewhat rocky path.
The first FDA-approved medication for alcohol treatment, disulfiram (Antabuse), was not a blockbuster drug in terms of efficacy. In the largest study of the drug, a 1-year trial, noncompliance with the medication was 80% and was associated with a lower rate of abstinence, Dr. Kranzler said.
A short-acting naltrexone formulation (Revia) came next, in 1994, initially demonstrating a “pretty robust effect” on abstinence and heavy drinking. But a meager 3-year exclusivity arrangement provided little incentive for the manufacturer to market the drug at that time.
Acamprosate (Campral), approved in 2004, may show a healthier acceptance rate. Studies in the United States and Europe suggest that the oral agent may not only double abstinence rates but also may have a meaningful effect on abstinence for as long as a year after discontinuation. Acamprosate is being heavily marketed to primary care physicians as well as psychiatrists and alcohol-dependency treatment specialists.
The Combining Medications and Behavioral Interventions (COMBINE) trial sponsored by the National Institute on Alcohol Abuse and Alcoholism is nearing completion. The trial will evaluate a multifaceted approach to alcohol-dependency treatment, comparing a placebo with two FDA-approved medications.
