Magazine article Clinical Psychiatry News

Injectable Naltrexone Shows Improved Efficacy

Magazine article Clinical Psychiatry News

Injectable Naltrexone Shows Improved Efficacy

Article excerpt

NEW YORK -- An injectable depot formulation of naltrexone, now in phase III trials, may help overcome the adherence problems that have compromised the drug's efficacy in the treatment of alcohol dependence, Helen M. Pettinati, Ph.D., said at the annual conference of the Association for Research in Nervous and Mental Disease.

Naltrexone is one of three drugs that have received approval from the Food and Drug Administration for alcoholism. The compound, an opioid antagonist first used for opiate addiction, blocks reward pathways in the brain. It appears to reduce the excitement that some derive from alcohol ingestion, as well as alcohol craving.

Treatment with naltrexone appears less consistent with total abstinence than with reduction in excessive drinking.

Of 24 double-blind controlled trials, 77% found that there was significantly less harmful drinking with the drug, compared with placebo, but many found that there was no difference in drinking days or other measures of abstinence.

Clinically, compliance difficulties have limited the utility of naltrexone, according to Dr. Pettinati, who is professor of psychiatry at the University of Pennsylvania in Philadelphia.

In one study, rates of relapse to heavy drinking were significantly lower among 60 naltrexone patients than among 44 placebo patients who attended 80% of clinic visits (10% vs. 38%). But there was no difference in relapse rate between 50 patients who were nonadherent to placebo and 42 who failed to follow the naltrexone regimen: 40% vs. 42%, respectively.

Attention to adherence should be a routine, proactive part of naltrexone treatment. Dr. Pettinati said.

The actual use of the medication may be monitored with blister packs or diaries. "If there's a poor response to treatment, ask about adherence--it's one of the most common explanations," she pointed out at the meeting, which was cosponsored by the New York Academy of Medicine. …

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