Prospects for Pharmacotherapies to Treat Alcohol Use Disorder

An Update on Recent Human Studies

Mehdi Farokhnia; Brittney D. Browning; Lorenzo Leggio

Disclosures

Curr Opin Psychiatry. 2019;32(4):255-265. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: The aim of this study was to provide an update on medication development efforts for alcohol use disorder (AUD) by reviewing recently published (past 2 years) human studies that evaluated medications' effects on alcohol-related outcomes.

Recent findings: Forty-five publications were found suitable for this review. A variety of compounds have been tested in the past 2 years as potential pharmacological options for AUD, including medications that act on multiple targets (topiramate, aripiprazole, quetiapine), calcium channels (gabapentin), gamma-Aminobutyric acid receptors (baclofen, diazepam), glutamate receptors (ifenprodil, memantine, glycine), nicotinic acetylcholine receptors (varenicline, mecamylamine), α1 adrenergic receptors (prazosin, doxazosin), neuroendocrine pathways (oxytocin, a vasopressin receptor 1b antagonist, a ghrelin receptor inverse agonist) and others (samidorphan, ibudilast, N-acetylcysteine, citoline). Important findings and limitations regarding the effects of these medications on alcohol-related outcomes are discussed.

Summary: There is a critical need to increase the armamentarium of medications for AUD. Human laboratory studies may help screen and prioritize promising targets and compounds before running large clinical trials. Given the complexity of AUD and the heterogeneity of afflicted patients, future studies should also investigate potential moderators and predictors of response to each pharmacological intervention.

Introduction

Alcohol represents a leading risk factor for premature death and disability, and alcohol use disorder (AUD) affects nearly 283 million people worldwide.[1,2] In addition to psychosocial interventions that play an important role in AUD treatment, four medications have been approved by the United States Food and Drug Administration and/or the European Medicines Agency: disulfiram, acamprosate, naltrexone and nalmefene (the latter is only approved in Europe). Although meta-analyses show that currently approved medications are effective,[3] there is a critical need to increase the armamentarium of pharmacotherapies for AUD. Neuroscientific advances have led to identification of novel therapeutic targets and development of new medications in this regard.[4] The goal of this article is to provide an update on medication development efforts for AUD by reviewing human studies published in the past 2 years.

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