title: Sodium oxybate plus nalmefene for the treatment of alcohol use disorder: A case series.
abstract: The treatment of alcohol use disorder still remains a challenge. The efficacy of the combined pharmacological treatment for alcohol use disorder has been widely investigated with controversial results. The aim of our case series was to investigate the effect of nalmefene in patients not responding to sodium oxybate therapy. We describe seven cases of consecutive patients affected by alcohol use disorder, and treated with sodium oxybate (50 mg/kg per day) who did not achieve complete alcohol abstinence after at least one month of pharmacological treatment. Then, in partial- and non-responder patients to sodium oxybate treatment, administration of nalmefene, 18 mg as needed, was commenced. Our data show that, during the first month of the combined treatment of sodium oxybate plus nalmefene, patients were able to achieve alcohol abstinence (two patients), to suppress (five cases) or reduce (two patients) episodes of heavy drinking days, and to suppress the onset of craving for sodium oxybate (one patient). Likely, nalmefene may act in modulating the excessive reward effect of sodium oxybate, which may be responsible for the persistence of alcohol intake and for the onset of craving for sodium oxybate. However, controlled clinical trials to confirm the safety and efficacy of sodium oxybate plus nalmefene in treating alcohol use disorder are warranted.
authors: Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy f.caputo@ausl.fe.it.
authors: Fabio
authors: F
authors: Caputo
authors: Vincent P Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara Hospital, University of Pisa, Pisa, Italy.
authors: Angelo G I
authors: AG
authors: Maremmani
authors: Alcohol Use Disorders Unit, Department of Internal Medicine, Catholic University of Rome, Rome, Italy.
authors: Giovanni
authors: G
authors: Addolorato
authors: 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy.
authors: Marco
authors: M
authors: Domenicali
authors: Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy.
authors: Giorgio
authors: G
authors: Zoli
authors: Centre for The Treatment of Alcoholism, Region of Campania, Aversa, Italy.
authors: Antonio
authors: A
authors: D'Amore
authors: Vincent P Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara Hospital, University of Pisa, Pisa, Italy.
authors: Icro
authors: I
authors: Maremmani
authors: 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy.
authors: Mauro
authors: M
authors: Bernardi
mesh_terms: D000328:Adult; D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000188:drug therapy*; D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D000437:Alcoholism / Q000188:drug therapy*; D000438:Alcohols / Q000008:administration & dosage; D066249:Craving / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D012978:Sodium Oxybate / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000438:Alcohols; D009292:Narcotic Antagonists; D009271:Naltrexone; D012978:Sodium Oxybate; C038981:nalmefene
keywords: Treatment of alcohol use disorder; nalmefene; sodium oxybate