Efficacy

Acamprosate has a dose-related effect of improving abstinence rates in recently detoxified patients. (4 48 and 49 Large randomized controlled studies of acamprosate^0,51ยป have shown an increase, compared with placebo, in the percentage remaining totally abstinent for 12 months from 10 to 25 per cent to 20 to 50 per cent, a doubling of the time to first relapse, and a halving of total alcohol consumed. There are no studies comparing the advantages of differing lengths of treatment. Systematic follow-up after the end of drug or placebo treatment shows no sudden relapse and no discontinuation symptoms in patients who have received acamprosate for up to 1 year/5,!,)

Several studies have shown that acamprosate reduces self-reported craving for alcohol; one of these failed to find an effect on drinking. (52) Some newly abstinent patients experience strong craving, but others experience very little.

Acamprosate has only been tested in patients who intend to abstain from alcohol. It has not been shown to assist patients aiming for controlled drinking. Suggested mode of use

Acamprosate is indicated for patients who have typical severe alcohol dependence requiring medical assistance to withdraw. It is started 2 to 7 days after the last drink. Steady state pharmacokinetics are reached after 5 days. It is given in a dose of 1998 mg daily divided through the day. Patients who relapse while on acamprosate are advised to continue taking the medication and exert effort to limit the lapse. However, acamprosate is not normally continued in patients who relapse more than once despite regularly taking the drug. About 50 per cent or more of patients do not benefit from acamprosate. Those who appear to be benefiting from it should continue the drug for at least 6 months, and up to 1 year if there has been previous relapse in treatment.

Patients taking disulfiram randomly allocated to acamprosate seem to be more successful than patients taking disulfiram and placebo, (53> suggesting that acamprosate's potential to reduce craving in newly abstinent patients may help them to continue taking disulfiram. The reverse procedure, i.e. randomly allocating patients taking acamprosate to disulfiram or control, has not been carried out.

Naltrexone

Naltrexone antagonizes endorphins which are released in one of ethanol's many acute actions on the limbic system. It has been suggested that this action contributes to loss of control.(54) Naltrexone reduces ethanol seeking in dependent animals. It does not exacerbate the psychomotor impairment caused by alcohol.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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