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Alcohol and Alcoholism Advance Access originally published online on September 29, 2004
Alcohol and Alcoholism 2004 39(6):542-547; doi:10.1093/alcalc/agh093
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Alcohol & Alcoholism Vol. 39, No. 6 © Medical Council on Alcohol 2004; all rights reserved

COMBINED THERAPY: WHAT DOES ACAMPROSATE AND NALTREXONE COMBINATION TELL US?

FALK KIEFER* and KLAUS WIEDEMANN

Department of Psychiatry, University Hospital of Hamburg, Hamburg, Germany

* Author to whom correspondence should be addressed at: Department of Psychiatry and Psychotherapy, University Hospital of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany. Tel.: +49 40 42803 5356; Fax: +49 40 42803 3417; E-mail: kiefer{at}uke.uni-hamburg.de

(Received 9 June 2004; first review notified 28 July 2004; in revised form 8 August 2004; accepted 8 August 2004)

Aims: Relapse prevention treatment with both acamprosate and naltrexone has been shown to be efficacious in the treatment of alcoholism. Whereas both compounds act pharmacologically differently, there is up to now only limited evidence as to whether combined treatment is efficacious and pharmacologically safe. It remains to be answered whether data justify the combination of both drugs in clinical practice. Methods: Review of the three pre-clinical and four clinical studies that have been published to date on either combined tolerability or efficacy. Results: Data available up to now show no occurrence of severe adverse events during combined treatment. Diarrhoea and nausea were shown to be the most significant side-effects. Whereas pre-clinical studies regarding efficacy of combined treatment are not yet conclusive, clinical data show the superiority of combined treatment compared with both placebo and acamprosate monotherapy. The synergistic effect of combined treatment remained after 12 weeks of drug-free follow-up. Conclusions: The combination of acamprosate with naltrexone in a clinical sample seems to be efficacious and safe. Numerous alcohol dependent patients could benefit, particularly those that responded insufficiently on monotherapeutic treatment with either acamprosate or naltrexone.


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