The Drug Supports Alcohol Detoxification

Alcoholism is a very common problem in society today, it can have significant effects on social life as well as the health and psychophysiology of the addict.
Over the past two decades, although we have gained a lot of new insights into the neurochemical mechanisms of this phenomenon, we have found very few drugs to treat it.
Currently, only a number of drugs, including disulfiram, naltrexone, acamprosate, topiramate, nalmefene and ondansetron, have been licensed either in the research process or used empirically to treat alcohol dependence.
The effectiveness of each medication can vary significantly between patients and some may not respond to any medication. It should be noted that all of these drugs cannot be effective without being accompanied by psychological and behavioral treatments

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Disulfiram
60 years ago, disulfiram was discovered by chance that could cause an alcohol-fear reaction. Alcohol ethanol in alcohol is metabolized by a system of enzymes, including the enzyme aldehyde dehydrogenase.
Disulfiram does not reverse this enzyme, resulting in the stagnation of toxic intermediates metabolites called acetaldehyde because it is not metabolized
If disulfiram is present in the body, whenever a person drinks alcohol, it will accumulate acetaldehyde, which can cause a complex of unpleasant sensations such as nausea, vomiting, hot flashes, hypotension, etc.



called the disulfiram-ethanol reaction.
This reaction can make people feel afraid to drink alcohol, the degree of reaction is proportional to the dose of disulfiram and the amount of alcohol consumed.
Disulfiram is not widely used in practice due to the risk of side effects and drug interactions. The most common side effect is drowsiness, which can be overcome by taking medication at night.
Drug-induced hepatotoxicity can also occur very early, so routine monitoring of liver function tests should be performed during drug administration.
Due to side effects as well as the risk of lowering blood pressure in disulfiram-ethanol reaction, should be avoided in people with cardiovascular disease, cerebrovascular disease, diabetes, psychosis or cognitive disorders.
In addition, disulfiram can interact with a range of drugs that are metabolized via the cytochrome P-450 enzyme system such as theophyllin, phenytoin, warfarin, etc , leading to increased toxicity.



Therefore, reduce the dose or avoid taking these drugs with disulfiram.
The maximum dose of disulfiram in alcohol dependence treatment is 500mg / day. The effect of disulfiram on alcohol withdrawal is maximized only when the patient's drug compliance and strict monitoring of treatment.
Naltrexone
An opioid receptor competitive substance, commonly used in opiate detoxification. Naltrexone may reduce the desire to drink alcohol by blocking the beta-endorphin pathway, in addition, the drug also reduces the feeling of excitement after drinking alcohol.
Most studies have shown that the drug can help reduce the intensity and frequency of alcohol consumption when used as directed. People with a family history of alcoholism often respond well to naltrexone.
In addition, the stronger the desire for alcohol to be before treatment, the more likely it is that the drug will respond.




Adherence to medication is also the most important factor determining the effectiveness of naltrexone treatment, this effect is only guaranteed when the patient must use at least 70 - 90% of the prescribed drug.
The slow-release form of intramuscular injection every 4 weeks of naltrexone may help improve adherence.
The common side effects of the drug are nausea, dizziness and fatigue, and hepatotoxicity may occur but is rare at doses of 50 mg / day. The drug should be avoided in patients with impaired hepatic function or heroin and opiate dependence.
Nalmefene
Also an opioid receptor competitor, currently being studied in the treatment of alcohol dependence. Although there is no evidence that nalmefene is more effective than naltrexone, it may be safer because this drug does not cause liver toxicity.
Acamprosate
This is the agent that proves the most pronounced effect in the treatment of alcohol dependence, the exact mechanism of action is unknown but it may be due to the inhibition of glutamatergic system leading to decreased desire for drinking.
To ensure effectiveness, acamprosate should be taken as soon as possible and used continuously for a long time to reduce the frequency and level of alcohol consumption.



Because the drug is excreted by the kidneys, the dose should be reduced or avoided in patients with severe renal impairment.
The most common side effect of acamprosate is diarrhea, but it is usually mild and transient. The therapeutic effect of acamprosate may increase when the drug is used in combination with naltrexone.
Topiramate
As an anti-epileptic drug, topiramate has effects that help the treatment of alcohol dependence such as GABA inhibitors and glutamate transmission inhibitors.
Currently, due to too few studies on topiramate alcohol dependence effects, the drug is often used for only.

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