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DOI: 10.1055/s-0033-1355362
Aktueller Stand der pharmakologischen Rückfallprophylaxe der Alkoholabhängigkeit
Current Status of Pharmacological Relapse Prevention of Alcohol DependencePublication History
Publication Date:
13 November 2013 (online)
![](https://www.thieme-connect.de/media/suchttherapie/201304/lookinside/thumbnails/10.1055-s-0033-1355362-1.jpg)
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.
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