Antikonvulsiva in der Behandlung der Alkoholabhängigkeit

Zusammenfassung

Zur Behandlung der Alkoholkrankheit sind in den letzten 40 Jahren aufgrund richtungweisender Tierexperimente zunehmend klinische Studien mit Antikonvulsiva durchgeführt worden. An dieser Stelle werden die anhand einer ausführlichen Suche in MEDLINE, EMBASE und Cochrane gefundenen klinischen Studien mit dem Ziel vorgestellt, sie in Anlehnung an die Leitlinien der Arzneimittelkommission der deutschen Ärzteschaft zu bewerten. Betrachtet wurden klinische Studien zur Behandlung des Alkoholentzugssyndroms, zur Rückfallprävention bzw. Trinkmengenreduktion und zur Behandlung komorbider psychischer Störungen. Die Studienanalyse ergibt bisher keine sicheren Alternativen zu Benzodiazepinen, Clomethiazol und Carbamazepin in der alleinigen Behandlung des stärkeren Alkoholentzugssyndroms. Auch bezüglich der Rückfallprävention/Trinkmengenreduktion und Behandlung komorbider Störungen ist die Studienlage für Antikonvulsiva noch nicht zufriedenstellend. Die sichersten Wirksamkeitsnachweise liegen hier zurzeit für Topiramat (Trinkmengenreduktion) und Valproat (Alkoholkrankheit mit bipolarer Störung) vor, die allerdings noch durch hinreichend große kontrollierte Studien von längerer Dauer bestätigt werden müssen. Am Horizont scheinen Baclofen und einige Antikonvulsiva wie Valproat, Oxcarbazepin und Gabapentin ein vielversprechendes Potenzial zur unterstützenden Behandlung der Alkoholerkrankung zu bieten. Zu Levetiracetam, das aufgrund seines Sicherheitsprofils und seiner geringen Interaktionsbereitschaft besonders geeignet wäre, sind noch keine kontrollierten Studien publiziert.

Abstract

Because of promising data from animal studies the clinical trials on anticonvulsants for the treatment of alcohol disorder have been accumulating in the last 40 years. A comprehensive research of various data bases (MEDLINE, EMBASE, Cochrane) was performed. Here, we present the trials found together with an estimation of their evidence according to the guidelines of the “Arzneimittelkommission der deutschen Ärzteschaft”. We examined the clinical studies conducted for the treatment of alcohol withdrawal syndrome, for relapse prevention/consumption reduction as well as for the treatment of co-morbide psychiatric disorders. The study analysis has not resulted in any safe alternative to benzodiazepines, clomethiazole or carbamazepine in the treatment of the stronger alcohol withdrawal syndrome. The material is also insufficient with regard to relapse prevention/consumption reduction or to the treatment of co-morbide psychiatric disorders. The safest proof of effect is currently topiramate (consumption reduction) and valproate (alcohol dependence with bipolar disorder). However, first positive results must be confirmed in well controlled studies with a much longer duration. Baclofen und several anticonvulsants such as valproate, oxcarbazepine and gabapentin demonstrate a potential to aid in the treatment of alcohol disorder. Currently, there exists any published controlled study for levetiracetam, which would be well suited in the treatment of alcoholism due to its favorable safety profile and low pharmacological interaction potential.

Schlüsselwörter

Alkoholabhängigkeit - Alkohol - Antikonvulsiva - akutes und protrahiertes Entzugssyndrom - Rückfallprävention

Key words

alcoholism - alcohol - anticonvulsants - acute and protracted withdrawal symptoms - relapse prevention

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