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Suchttherapie 2013; 14(04): 170-177
DOI: 10.1055/s-0033-1355362
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Aktueller Stand der pharmakologischen Rückfallprophylaxe der Alkoholabhängigkeit

Current Status of Pharmacological Relapse Prevention of Alcohol Dependence
E. Pape
1   Zentrum für Abhängigkeitserkrankungen, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Schweiz
,
M. Herdener
1   Zentrum für Abhängigkeitserkrankungen, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Schweiz
,
S. Rösner
2   Forel Klinik, Ellikon an der Thur/Schweiz
,
M. Grosshans
3   Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg
,
J. Mutschler
1   Zentrum für Abhängigkeitserkrankungen, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Schweiz
› Author Affiliations
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Publication History

Publication Date:
13 November 2013 (online)

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Zusammenfassung

In dieser klinisch orientierten Übersicht soll ein Überblick über die zur Alkoholrückfallprophy­laxe verfügbaren Medikamente in Deutschland und die aktuelle Studienlage gegeben werden. Kurz werden auch Kombinationsmöglichkeiten angesprochen und mögliche Strategien der Behandlungsoptimierung vorgestellt.

Acamprosat, Naltrexon und ganz neu Nalmefene sind derzeit in Deutschland für die rückfallprophylaktische Behandlung der Alkoholabhängigkeit zugelassen. Disulfiram, die wirksamste der Substanzen, hat im April 2011 in Deutschland die Zulassung verloren, da die Herstellerfirma das Medikament aufgrund „technologischer Schwierigkeiten“ nicht mehr produziert. Disulfiram kann aber weiterhin über internationale Apotheken bezogen und eingesetzt werden. Die Datenlage zu Acamprosat ist bei unselektiertem Einsatz kontrovers. Wahrscheinlich profitiert nur ein Anteil von ca. 30% der Patienten von der Medika­tion, die zukünftige therapeutische Bedeutung wird daher von der Identifikation dieses Anteils an Respondern abhängig sein.

Die Studienlage für Naltrexon sieht bei moderater Effektstärke etwas günstiger aus, v. a. hinsichtlich der prophylaktischen Wirkung hinsichtlich eines Rückfalls in übermäßiges Trinken.

Der Opiatantagonist Nalmefene, der kurz vor der Markteinführung in Deutschland steht – als erstes Medikament explizit für die Indikation Trinkmengenreduktion – ermöglicht potentiell eine Öffnung gegenüber einer bislang mit Abstinenz-orientierten Therapiestrategien nicht erreichten Patientenpopulation.

Zuletzt sollen kurz Medikamente vorgestellt werden, die im off-label Bereich eingesetzt werden (z. B. Baclofen, Topiramat) oder sich in der Entwicklung befinden und sich z. T. ganz neuartiger Wirkstrategien (Neurokinin-1-Rezeptorantagonismus) bedienen.

Abstract

This review with practical clinical focus offers an overview of available medication in Germany and current knowledge of treatment outcomes. Further, potential strategies of optimizing individual treatment of alcohol dependence are discussed.

Acamprosate, naltrexone and most recently nalmefene are approved in Germany for pharmacologic relapse prevention in alcohol dependent patients. In April 2011, disulfiram though being the most effective of the authorized substances lost its approval because the manufacturer no longer produces the drug due to “technological pro­blems”. However, disulfiram still remains rather easily obtainable via international pharmacies.

Available evidence of relapse prevention for acamprosate if administered to a heterogeneous patient population is controversial. It has been suggested that only a specific group of patients might respond to acamprosate treatment. Its future therapeutic relevance will therefore depend on identifying this group of patients.

Current data for efficacy of naltrexone seem to be slightly more favorable showing some reduction on relapse probability to heavy drinking while effects on return to any drinking missed statistical significance in a recent meta-analysis. The opiate antagonist nalmefene is the first medication explicitly authorized for reduction of alcohol consumption and will shortly be introduced to the German market. The substance might embrace a wider patient population that has not yet been reached by abstinence oriented treatment strategies.

Finally, treatment options administered in off-label-use (like baclofen, topiramat) are briefly introduced as well as substances which are currently under development using novel pharmacological mechanisms of action.

Schlüsselwörter

Alkoholabhängigkeit - Rückfallprophylaxe - Nalmefene - Disulfiram - Acamprosat

Key words

alcohol dependence - relapse prevention - nalmefene - disulfiram - acamprosate
 

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