Intramuscular extended-release naltrexone: current evidence
Intramuscular extended-release naltrexone: current evidence
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DOI：
10.1111/j.1749-6632.2010.05900.x
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发表时间：
2011-01-01
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影响因子：
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通讯作者：
Gastfriend, David R.
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作者：
Gastfriend, David R.
缓释纳洛酮（XR-NTX; Vivitrol（R）），开发用于解决成瘾性疾病的依从性差，被批准用于酒精和阿片类药物依赖性疾病。在酒精依赖的成年人与>= 4天的初始禁欲，XR-NTX增加初始和6个月的禁欲。一项fMRI研究发现，XR-NTX在没有酒精的情况下减弱了酒精视觉和嗅觉线索的显着性，事后分析表明，即使在高线索暴露的假期期间也有效。安全性和耐受性通常良好，无不良肝脏影响或难治性急性疼痛管理。XR-NTX在初级保健和公共系统中的使用似乎是可行的，回顾性索赔分析发现，相对于口服药物，XR-NTX可以节省成本，降低密集服务利用率。在阿片类药物依赖中，脱毒后，XR-NTX显示出维持戒断、改善保留、减少渴望和预防复发的功效。试验也在探索其用于治疗兴奋剂依赖。XR-NTX似乎与咨询和自助出勤兼容。虽然需要更多的研究，但目前的研究结果表明，三十多年前开始寻求的纳洛酮制剂正在实现其作为缓释药物的承诺。
Extended-release naltrexone (XR-NTX; Vivitrol (R)), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with >= 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.