Effects of topiramate on urge to drink and the subjective effects of alcohol: A preliminary laboratory study
Effects of topiramate on urge to drink and the subjective effects of alcohol: A preliminary laboratory study
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DOI：
10.1111/j.1530-0277.2007.00592.x
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发表时间：
2008-03-01
影响因子：
3.2
通讯作者：
McGeary, John
中科院分区：
文献类型：
--
作者：
Miranda, Robert, Jr.;MacKillop, James;McGeary, John
背景：最近在一项随机对照试验中，托吡酯被报道对降低酒精依赖个体的饮酒率和渴望有效，但剂量效应无法确定。本实验室研究系统地考察了托吡酯对线索引发的渴望的剂量依赖性作用及其对饮酒的药物治疗作用的其他假定机制。方法：在一项双盲研究中，男性和女性重度饮酒者（n = 61）随机分为三组（200 mg/d; 300 mg/d；安慰剂）。参与者在32天的滴定期后达到目标剂量，然后稳定约1周。然后，所有人都参加了酒精线索反应性和中等剂量酒精的主观影响的实验室评估。结果：与安慰剂相比，两种剂量的托吡酯在滴定期间减少了大量饮酒的频率。然而，托吡酯在滴定期间、提示反应方案期间或对酒精挑战程序的反应中不影响自我报告的酒精渴望。与安慰剂相比，托吡酯减少了酒精摄入的刺激作用，但仅限于200毫克组。结论：本研究的结果支持之前的研究结果，即托吡酯减少饮酒，但这种效果的行为机制似乎并不是用本研究中采用的方法测量的对酒精的渴望的衰减。相反，结果初步表明托吡酯可能通过改变饮酒的主观体验来发挥其有益作用。讨论了当前研究的局限性，并提出了今后研究的补充方法，如使用行为经济学范式和生态瞬时评价。
Background: Topiramate was recently reported to be efficacious in reducing drinking rates and craving among individuals with alcohol dependence in a randomized controlled trial, but dose effects could not be determined. This laboratory study systematically examined the dose-dependent effects of topiramate on cue-elicited craving and other putative mechanisms of its pharmacotherapeutic effects on drinking.Methods: Male and female heavy drinkers (n = 61) were randomized to 1 of 3 medication conditions (200 mg/d; 300 mg/d; placebo) in a double-blind study. Participants reached the target dose after a 32-day titration period, then were stabilized for approximately 1 week. All then participated in a laboratory assessment of alcohol cue reactivity and of the subjective effects of a moderate dose of alcohol.Results: Both doses of topiramate reduced the frequency of heavy drinking during the titration period as compared to placebo. However, topiramate did not affect self-reported craving for alcohol during the titration period, during the cue reactivity protocol, or in response to the alcohol challenge procedure. Topiramate reduced the stimulating effects of alcohol ingestion compared to placebo, but only in the 200 mg group.Conclusions: The results of this study support previous findings that topiramate reduces drinking, but the behavioral mechanism underlying this effect does not appear to be attenuation of craving for alcohol as measured using the approaches employed in this study. Rather, the results tentatively suggest that topiramate may exert its beneficial effects by altering the subjective experiences of alcohol consumption. Limitations of the current study are discussed and complementary methods are recommended for future studies, such as the use of behavioral economic paradigms and ecological momentary assessment.