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Prospects for pharmacotherapies to treat alcohol use disorder

an update on recent human studies

Farokhnia, Mehdia,b,*; Browning, Brittney D.a,*; Leggio, Lorenzoa,b,c,d

Current Opinion in Psychiatry: July 2019 - Volume 32 - Issue 4 - p 255–265
doi: 10.1097/YCO.0000000000000519
ADDICTIVE DISORDERS: Edited by John B. Saunders and Linda B. Cottler
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Purpose of review The aim of this study was to provide an update on medication development efforts for alcohol use disorder (AUD) by reviewing recently published (past 2 years) human studies that evaluated medications’ effects on alcohol-related outcomes.

Recent findings Forty-five publications were found suitable for this review. A variety of compounds have been tested in the past 2 years as potential pharmacological options for AUD, including medications that act on multiple targets (topiramate, aripiprazole, quetiapine), calcium channels (gabapentin), gamma-Aminobutyric acid receptors (baclofen, diazepam), glutamate receptors (ifenprodil, memantine, glycine), nicotinic acetylcholine receptors (varenicline, mecamylamine), α1 adrenergic receptors (prazosin, doxazosin), neuroendocrine pathways (oxytocin, a vasopressin receptor 1b antagonist, a ghrelin receptor inverse agonist) and others (samidorphan, ibudilast, N-acetylcysteine, citoline). Important findings and limitations regarding the effects of these medications on alcohol-related outcomes are discussed.

Summary There is a critical need to increase the armamentarium of medications for AUD. Human laboratory studies may help screen and prioritize promising targets and compounds before running large clinical trials. Given the complexity of AUD and the heterogeneity of afflicted patients, future studies should also investigate potential moderators and predictors of response to each pharmacological intervention.

aSection on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health

bCenter on Compulsive Behaviors, National Institutes of Health, Bethesda

cMedication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland

dCenter for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA

Correspondence to Mehdi Farokhnia, MD, 10 Center Drive (10CRC/15330), Room 1–5413, Bethesda, MD 20892-1108, USA. Tel: +1 301 435 9398; e-mail: mehdi.farokhnia@nih.gov

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