Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Overview of Drugs
Potential acamprosate side effects can include changes in blood pressure, arrhythmias,
mood disorders, allergies, and gastrointestinal upset. It can sometimes be difficult
to determine whether side effects are caused by withdrawal or this medication,
and patients should request a medical evaluation if they are concerned about their
symptoms. An appointment with a doctor can also provide an opportunity to discuss
therapeutic progress and to receive evaluation for complications of alcoholism like
organ damage and malnutrition.
59
Citation: http://images.wisegeek.com/close-up-of-alcohol-with-man-blurred-behind-it.jpg
Patients who take acamprosate while in therapy appear to be more successful
with drinking cessation programs than those who do not take this medication. The
mechanics of alcohol addiction are complex, however, and not all patients experience
positive results. If one course of treatment does not appear to be effective for a
patient, it is possible to explore other options with the assistance of a counselor
or therapist to see if there is a more effective treatment program available.
Naltrexone
Naltrexone is an opioid receptor antagonist approved by the US FDA in 1994
that reduces heavy drinking by diminishing the rewarding neurobiological effects
of alcohol. It acts via reducing dopamine release in response to alcohol from the
dopamine reward pathways in the ventral tegmental area and the nucleus accumbens.
It is also known to reduce the release of endogenous opioids like endorphins in
response to alcohol
60
Naltrexone hydrochlorideb is a type of medication that acts as an opioid antagonist.
This means it is able to impair or block the effects opioids have on the body. Some
of the opioids naltrexone blocks are heroin, morphine, and codeine. Essentially, this
drug works by blocking the parts of the brain that cause someone to feel euphoric
or good when exposed to narcotic drugs. It can be used for fighting dependency
on opioids.
Naltrexone may also be used in the treatment of alcoholism. So far, no one knows
for sure what makes the medication so effective in the treatment of alcoholism.
However, patients report a reduction in the urge to drink. Also, the medication may
stop an alcoholic from drinking more and more if he deviates from his recovery
and has an alcoholic beverage.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: https://fthmb.tqn.com/0pQ7QnbYeEZM-e38RecWzP0ysFk=/1500x1000/filters:no_
upscale():fill(87E3EF,1)/about/GettyImages-57158282web-5716f8ba3df78c3fa2e7abcb.jpg
This anticraving agent is a competitive opioid antagonist which blocks the euphoric
and reinforcing effects of alcohol.
Randomised controlled trials have shown:
■ Trials of naltrexone in the treatment of alcoholism are recent and of
generally good quality.
■ There is good evidence that naltrexone reduces relapse and number of
drinking days in alcohol-dependent subjects.
■ There is some evidence that naltrexone reduces craving and enhances
abstinence in alcohol-dependent subjects.
Overview of Drugs
■ There is good evidence that naltrexone has a favorable harms profile.
■ reductions in the amount and frequency of drinking overall
■ reductions in the rate and relapse into heavy drinking (where relapse is
defined as a return to > 5 drinks per day)
■ increased rates of alcohol abstinence
Both naltrexone and acamprosate are available on the Pharmaceutical Benefits
Scheme (PBS) for use within a comprehensive treatment program
■ Oral naltrexone: Naltrexone exerts its principal pharmacological effects
through blockade of the mu-opioid receptor. Endogenous opioids are
involved in modulating the expression of alcohol’s reinforcing effects. Mice
that lack the mu-opioid receptor do not self-administer alcohol. Naltrexone
also modifies the hypothalamic-pituitary-adrenal axis to suppress ethanol
consumption.
The usual dose of naltrexone is 50 mg/day, but some trials have used up to 100
mg/day.
■ Efficacy: Multiple metaanalysis of clinical trials for alcohol dependence
found naltrexone to reduce alcohol consumption compared with placebo.
As an example, a 2010 meta-analysis of 50 randomized trials with 7793
alcohol dependent participants found that naltrexone reduced the risk of
heavy drinking to 83 percent of the risk in the placebo group and decreased
drinking days by about 4 percent. Naltrexone may be particularly efficacious
in individuals with genetic susceptibility. Preliminary evidence suggests
that individuals with the Asp variant of the OPRM1 gene are less likely to
experience relapse when receiving naltrexone, but further study is needed
to confirm the finding. Patients who were heterozygous for the Asp-40
allele were almost six times more likely to have a favorable outcome with
naltrexone treatment than those who did not carry this allele.
■ Adverse effects: Common side effects of oral naltrexone are nausea,
headache, and dizziness, which subside with continued use. Fivefold
elevation in liver enzymes occurred in 11 of 614 patients who received
naltrexone in the COMBINE Study. Enzyme levels returned to baseline
after discontinuation of medication in the nine patients who had stopped
drinking and returned for follow-up. Liver enzymes should be monitored
periodically during naltrexone treatment.
Generally speaking, naltrexone can block effects of opioids very quickly after
taking just one dose. Effects with alcoholism may occur fairly soon as well. Some
experts assert that the drug is most effective when combined with other treatment
mechanisms, such as therapy. It is not addictive, and it doesn’t cause psychological
effects; most people do not feel as if they are high on drugs when they are on it.
Additionally, the medication is not supposed to interfere with types of pleasure that
do not come from opiate drug use or from the consumption of alcoholic beverages.
61
62
Citation: http://images.wisegeek.com/needle-lighter-spoon-heroin.jpg
Naltrexone causes side effects in only a small amount of the people who receive
it. When side effects do occur, they tend to be fleeting and mild. Some people on
naltrexone may experience such things as nausea, anxiety, fatigue, and headaches;
others on the medication may experience dizziness and insomnia. Though most people
can take naltrexone without any serious side effects, there is the possibility that the
drug will be toxic to the liver. For this reason, patients may have to undergo blood
tests to evaluate liver function before starting treatment as well as during treatment.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
There are some people who should not take naltrexone, such as pregnant women.
Some people with liver or kidney damage may not be good candidates for using
this medication. However, this depends on the level of damage and the overall
health of the patient. Additionally, it may not be used in patients who cannot
abstain from drinking alcoholic beverages for at least five days before beginning
treatment. Likewise, those who are addicted to opiates must be able to abstain for
at least seven full days before they start taking the medication.
Naltrexone Implant
Naltrexone is a medication that can prevent an addict from experiencing pleasure
from drugs or alcohol. It works by blocking certain receptors in the brain that respond
to alcohol and opiate drugs, such as heroin and certain painkillers. A naltrexone
implant is placed under the skin of a person undergoing addiction treatment and
slowly releases the medication over time.
A person who is addicted to opiate drugs can use a naltrexone implant as part of
a recovery plan. The implant is made of a substance that dissolves over time in the
body, releasing the drug slowly. It works for up to three months. The naltrexone
binds to opiate receptors that were previously stimulated by the addict’s drug of
choice. With the receptors blocked, the drug produces the same effects as usual,
Overview of Drugs
but the addict feels less pleasure from taking the drug. This alteration of an addict’s
brain chemistry also means that cravings for a substance can become weaker and
easier to overcome.
Citation: http://images.wisegeek.com/woman-lying-on-white-counter-near-bottle-of-alcohol.
jpg
63
The treatment is also available in a pill or as an injection. Addicts may need to take
the pill form every day and receive a new injection every month. The advantage of
delivering naltrexone in a slow-release implant is that the patient does not have to
remember to take the medication regularly and cannot skip doses if he or she feels
like it. A disadvantage of delivering the drug in an implant form is that surgery is
necessary to remove it if the naltrexone produces unpleasant side effects.
Mild side effects from the naltrexone include gastrointestinal issues, headaches, and
muscle or joint pain. Less common side effects are dizziness, chills, and an increase
in heart rate. Severe issues that necessitate medical advice include depression,
hallucinations, and chest pain.
The procedure of implantation also carries a risk of infection or inflammation. The
withdrawal from a drug can be unpleasant for the addict. If a person who has a
naltrexone implant suffers severe pain from an accident or medical issue, the implant
will interfere with the painkilling effect of medical drugs, and so the implant may
have to be removed.
A drug rehabilitation program that includes the naltrexone implant also needs to
help addicts with behavioral issues. As the implant only helps protect against opiate
drugs and alcohol, the addict may begin abusing other drugs as a replacement for
the previous addiction. Even though the experience of taking drugs may be lessened,
an addicted person is still at risk of overdose.
64
Illustrated Handbook of Drugs & Alcohol Related Health Issues
How Effective is Naltrexone for Alcoholism
Naltrexone is a prescription medication used to combat alcoholism. It is an opioid
receptor antagonist that works to treat alcohol-dependent individuals. The drug is
also effective in the treatment of opioid dependence. Naltrexone for alcoholism is
administered through an injection by a health care professional or given orally by
tablet to outpatients. Research on the use of naltrexone for alcoholism has concluded
it is an effective deterrent to alcohol cravings.
A pair of studies published in 1992 regarding the effectiveness of using naltrexone
for alcoholism provided evidence of the drug’s effectiveness. Later studies continued
to support such results. Naltrexone, when used properly, reduces the risk of relapse
and the severity of relapses that do occur. In addition, the medication has proved
effective with or without the addition of psychotherapy or group addiction meetings.
Its effectiveness is believed to come from its impact on areas of the brain that
control risk-taking and pleasure-seeking behaviors.
Citation: http://images.wisegeek.com/stressed-woman-with-hand-on-head-and-man-
drinking-in-background.jpg
Once a patient is stabilized, he or she is typically prescribed one tablet per day.
Side effects of naltrexone for alcoholism include nausea and vomiting. These side
effects typically disappear within a few days of starting the medication. In addition,
an increase in liver enzyme levels is possible. Periodic blood tests can check for
Overview of Drugs
such increases, and dosages can be adjusted to reduce them.
Injectable naltrexone is used for clients who cannot be trusted to comply with taking
naltrexone tablets. It is also used in patients who have difficulty swallowing pills
or do not want to be tied to a daily medication regime. A monthly intramuscular
injection eliminates the need for tablets. It is a convenient treatment method, though
it does involve a monthly visit to a health care professional for the injection.
While it is not necessary to combine outpatient treatment with the use of naltrexone
for alcoholism, studies have shown that long-term success is more likely when
combined with at least 16 weeks of outpatient counseling treatment. Individual
counseling, group counseling, and 12-step meetings are among suggested outpatient
treatment methods. Naltrexone for alcoholism is a safe, relatively easy method used
to combat the disease. As with other addiction treatments, however, the alcoholic
must want to stop drinking for it to work long term.
65
Citation: http://images.wisegeek.com/woman-hands-on-head-eyes-closed.jpg
Different Naltrexone Side Effects
Naltrexone side effects may include gastrointestinal upset, headache, sleep disturbances
and a host of other uncomfortable symptoms. More serious side effects from this
drug may include breathing difficulties and difficulty swallowing. Although commonly
used for opioid addiction, in studies where its effectiveness for fibromyalgia has
been tested using very low doses, only a few very minor naltrexone side effects
have been reported.
66
Naltrexone is often used to treat individuals addicted to opiates by blocking the
effects of these drugs on the brain. In many instances, it may also help considerably
reduce the craving for drugs. Naltrexone side effects tend to be very slight when
used for opioid addiction, but they do exist. Perhaps one of the most alarming
naltrexone side effects is the liver function abnormalities it sometimes causes.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://images.wisegeek.com/woman-hand-over-mouth-hand-on-stomach.jpg
The most common naltrexone side effects tend to be minor and include upset
stomach, nausea, diarrhea and vomiting. Some may also experience an increase in
headaches while taking the drug or experience muscle or joint pain. These symptoms
are often easy to relieve with the use of over-the-counter medications.
More severe naltrexone side effects may indicate liver damage and require immediate
medical attention. These include severe abdominal pain, yellowing skin or eyes
and dark urine. Other severe naltrexone side effects include difficulty breathing,
coughing, facial swelling and tongue and throat swelling, as well as problems
swallowing. In some people, this drug may also cause allergic pneumonia. Pain,
inflammation, itching and redness on the skin where the medication was injected
may also signal an allergic reaction to the drug.
Overview of Drugs
67
Citation: http://images.wisegeek.com/man-in-orange-shirt-with-hands-on-chest.jpg
When taken orally, doctors recommend that naltrexone always be taken with food to
avoid unwelcomed stomach upset. Dizziness is sometimes reported as a side effect
of this drug, as is blurred vision and fainting. Side effects may also be experienced
if naltrexone is taken with other drugs, such as codeine, methadone or morphine.
Doctors recommend that individuals taking naltrexone avoid harmful interactions
by carrying medical information on them at all times to alert emergency personnel
that naltrexone is being used.
Low dose naltrexone side effects on clinical trial participants who have taken the
drug for possible fibromyalgia treatment are almost nonexistent. Occasionally,
participants have experienced graphic dreams. Actual physical side effects similar
to those sometimes experienced in patients taking higher doses for opioid addiction
do not appear to be a factor, however.
Disulfiram
An alcohol-sensitising agent which inhibits aldehyde dehydrogenase causing a toxic
build-up of acetaldehyde if alcohol is consumed. This results in unpleasant symptoms
such as facial flushing, nausea, vomiting, sweating and palpitations.
Randomised controlled trials have shown variable results and only a modest effect
in promoting abstinence. Disulfiram is not available on the PBS.
68
■ A substantial literature has been generated on the use of disulfiram in
alcoholism, but the number of controlled clinical trials is limited.
■ Controlled clinical trials of disulfiram reveal mixed findings. There is little
evidence that disulfiram enhances abstinence, but there is evidence that
disulfiram reduces drinking days. When measured, compliance is a strong
predictor of outcome.
■ Studies of disulfiram implants are methodologically weak and generally
without good evidence of bioavailability.
■ Studies of supervised disulfiram administration are provocative but limited.
Disulfiram is an aversive agent that does not directly influence motivation to drink,
but discourages drinking by causing an unpleasant physiologic reaction when
alcohol is consumed. Clinical trials suggest that disulfiram is effective principally
when taken routinely under supervised conditions.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Ciattion: http://www.alcoholrehabguide.org/app/uploads/2017/02/bigstock-Sick-man-taking-
medicine-in-be-71584030.jpg
Disulfiram inhibits aldehyde dehydrogenase and prevents the metabolism of alcohol’s
primary metabolite, acetaldehyde. Drinking alcohol while taking disulfiram results
in the accumulation of acetaldehyde in the blood, which causes unpleasant effects
such as sweating, headache, dyspnea, lowered blood pressure, flushing, sympathetic
overactivity, palpitations, nausea, and vomiting.
■ Contraindications:Contraindications to disulfiram include severe myocardial
disease and/or coronary occlusion, psychosis, or known hypersensitivity to
the medication or other thiuram derivatives. Disulfiram is generally avoided
in pregnant and nursing women.