Addiction Research Updates on Three Medications

ONDANSETRON is a medication used to treat nausea in chemotherapy patients and is sold under the name Zolfran. This medication appears to work through the serotoninergic system. Serotonin is implicated in alcoholic-drinking behavior, especially in regard to the serotonin3 receptor and its effect on dopamine. In alcoholics, it is possible that reduced serotoninergic function results in a heightened sensitivity of the serotonin3 receptor. If this receptor could be blocked, there would be a decrease in alcohol-induced dopamine release, resulting in a decrease in alcoholic-drinking behavior.

Ondansetron Research Notes: In his work with this serotonin antagonist, Dr. Bankole Johnson found that 4 micrograms of ondansetron per kilogram (.25 mg twice a day) seems to have the maximum effect. He also showed that early onset alcoholics (early age, broad range of antisocial behaviors, and a high family prevalence) did well with ondansetron and naltrexone combined, though this was only studied in 20 patients.

NALMEFENE is an opioid antagonist similar to naltrexone (ReVia). Recent research demonstrated that it may have advantages to naltrexone because there is no risk of liver toxicity, higher biologic activity than naltrexone (less is more), and it is longer acting.

Nalmefene Research Notes: Dr. Barbara Mason's research showed that patients treated with nalmefene during a 12-week trial were 2.4 times less likely to relapse from alcohol than those treated with a placebo. Dr. Elie Nuwayser is working on an injectable, sustained release form of nalmefene.

GABAPENTIN is an anticonvulsant sold under the name Neurontin. It is being used for pain management and anxiety, though some of the more interesting work is in the field of insomnia, a problem that is very common among alcohol-dependent patients.

Gabapentin Research Notes: Dr. Kirk Brown is studying its use in alcohol-dependent patients and has had good results in ameliorating the insomnia, when increased as needed (up to 1500 mg per day).