Hypothalamic-pituitary-adrenal system regulation in recently detoxified alcoholics is not altered by one week of treatment with acamprosate.
BACKGROUND
Acamprosate decreases relapse rates in alcohol-dependent patients by approximately 10-20% within the first year after detoxification. Psychological stress is a major risk fac-tor for relapse and is associated with activation of the hypothalamic-pituitary-adrenocortical (HPA) system. In recently detoxified alcoholics, the HPA system is dysregulated with non-suppression of cortisol after dexamethasone administration. We therefore investigated whether acamprosate normalizes HPA hyperactivity in alcoholics within the first 3 weeks of abstinence, employing a combined dexamethasone/corticotropin-releasing hormone (Dex-CRH)-test.


METHODS
Thirty alcohol-dependent patients were tested one week after withdrawal signs had disappeared. In 15 patients, acamprosate, 1332-1998 mg/day, was administered orally and a second Dex-CRH test was performed 1 week later. In the other 15 patients, acamprosate treatment was offered only after the second test.


RESULTS
CRH-stimulated cortisol secretion was significantly increased in both the acamprosate group and the group receiving no anti-relapse medication compared to a control group of 15 healthy subjects. Acamprosate treatment had no effect on basal or CRH-stimulated ACTH or cortisol secretion.


CONCLUSIONS
We conclude that 1 week of acamprosate treatment does not attenuate the HPA dysregulation ob-served during early abstinence.
Zimmerman
U
U
Max Planck Institute of Psychiatry, Munich, Germany. zimm@mpipsykl.mpg.de
Spring
K
K
Koller
G
G
Holsboer
F
F
Soyka
M
M
D000077443:Acamprosate; D000284:Administration, Oral; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy*; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016896:Treatment Outcome
D000427:Alcohol Deterrents; D013654:Taurine; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D000077443:Acamprosate; D006854:Hydrocortisone