Dosing Issues in the Pharmacotherapy of Alcoholism

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Abstract
Pharmacological treatments for alcohol dependence have focused increasingly on agents that reduce alcohol craving and consumption or that treat psychiatric disorders associated with drinking relapse. Clinicians who treat alcohol-dependent patients must find the optimal dose of these agents to maximize response. Determining the best dosing strategy has been the goal of recent treatment studies with alcohol-dependent patients. One study, for example, showed that an opiate antagonist medication had a dose-dependent relationship with patient outcome and retention in treatment. Another dosing consideration involves the effect of long-term alcohol abuse on drug metabolism (e.g., when treating alcohol-dependent patients for comorbid psychiatric disorders). This was demonstrated in a study of recently abstinent patients who were taking the antidepressant desipramine for major depression. Alcohol-dependent patients had higher hepatic enzyme activities and lower plasma levels of desipramine relative to oral dose than did a comparison group of depressed patients without an alcohol use disorder.