Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study.
BACKGROUND
Naltrexone and acamprosate have been shown to be effective in relapse prevention of alcoholism via different pharmacologic mechanisms. Since it remains uncertain whether both substances are equally efficient and whether a combination of both drugs potentiates the efficacy, we conducted the first published controlled study comparing and combining both compounds.


METHODS
After detoxification, 160 patients with alcoholism participated in a randomized, double-blind, placebo-controlled protocol. Patients received naltrexone, acamprosate, naltrexone plus acamprosate, or placebo for 12 weeks. Patients were assessed weekly by interview, self-report, questionnaires, and laboratory screening. Time to first drink, time to relapse, and the cumulative abstinence time were the primary outcome measures.


RESULTS
Naltrexone, acamprosate, and the combined medication were significantly more effective than placebo. Comparing the course of nonrelapse rates between naltrexone and acamprosate, the naltrexone group showed a tendency for a better outcome regarding time to first drink and time to relapse. The combined medication was most effective with significantly lower relapse rates than placebo and acamprosate but not naltrexone.


CONCLUSIONS
The results of this study support the efficacy of pharmacotherapeutic strategies in the relapse prevention of alcoholism. Naltrexone and acamprosate, especially in combination, considerably enhance the potential of relapse prevention.
Kiefer
Falk
F
Department of Psychiatry, University Hospital of Hamburg, Martinistr 52, D-20246 Hamburg, Germany. kiefer@psyunihh.de
Jahn
Holger
H
Tarnaske
Timo
T
Helwig
Hauke
H
Briken
Peer
P
Holzbach
Rüdiger
R
Kämpf
Philipp
P
Stracke
Robert
R
Baehr
Michael
M
Naber
Dieter
D
Wiedemann
Klaus
K
D000077443:Acamprosate; D000437:Alcoholism / Q000188:drug therapy* / Q000517:prevention & control*; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D010919:Placebos; D055502:Secondary Prevention; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016896:Treatment Outcome
D004338:Drug Combinations; D010919:Placebos; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate