title: A placebo controlled trial of memantine as an adjunct to oral naltrexone for opioid dependence.
abstract: BACKGROUND
  Preclinical findings suggest that the inhibition of NMDA glutamatergic neurotransmission may have beneficial effects in the treatment of opioid dependence.
  
  
  OBJECTIVE
  We hypothesized that memantine, a low-potency, uncompetitive NMDA receptor antagonist, would be safe and effective when used as an adjunct to oral naltrexone in the treatment of opioid dependence, particularly in preventing relapse to opiate use in detoxified individuals.
  
  
  METHODS
  Opioid-dependent participants (N=112) were enrolled. Following detoxification all participants were inducted onto oral naltrexone and were randomized to receive memantine 15 mg bid (N=27), memantine 30 mg bid (N=27) or placebo (N=27) for 12-weeks in combination with naltrexone 50mg/day and individual relapse-prevention therapy. The primary outcome was the retention in treatment since treatment dropout is most commonly associated with relapse to opiate use.
  
  
  RESULTS
  Twenty-six percent of participants withdrew from treatment prior to starting naltrexone. Of those that were randomized 35% completed 4 weeks only, and 24% completed all 12 weeks of treatment. There was no significant difference in treatment retention or heroin use, opiate withdrawal symptoms and craving between the groups treated with memantine vs. placebo.
  
  
  CONCLUSIONS
  Thus, the efficacy of memantine 30 or 60 mg/day as an adjunct to oral naltrexone for the treatment of opiate dependence was not supported.
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. amb107@columbia.edu
authors.forename: Adam
authors.initials: A
authors.lastname: Bisaga
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sullivan
authors.forename: Wendy Y
authors.initials: WY
authors.lastname: Cheng
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Carpenter
authors.forename: John J
authors.initials: JJ
authors.lastname: Mariani
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.forename: Wilfrid N
authors.initials: WN
authors.lastname: Raby
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D018450:Disease Progression; D015259:Dopamine Agents / Q000009:adverse effects / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008559:Memantine / Q000009:adverse effects / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D009271:Naltrexone / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010919:Placebos; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors*; D055502:Secondary Prevention; D015813:Substance Abuse Detection; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015259:Dopamine Agents; D009292:Narcotic Antagonists; D010919:Placebos; D016194:Receptors, N-Methyl-D-Aspartate; D009271:Naltrexone; D008559:Memantine