1. Dr. RAGHU PRASADA M S
MBBS,MD
ASSISTANT PROFESSOR
DEPT. OF PHARMACOLOGY
SSIMS & RC.
1

2.  Taking a Drug for any reason
other than a medical one…
 To get a feeling of
euphoria (high)
2

3.  uncontrollable compulsive drug
seeking and use, even in the face of
negative health and social
consequences.”
 Results from both psychological and
physical dependence on the drug
3

4.  Treatment of withdrawal symptoms
 Aversion therapy
 To reduce craving
 To prevent relapse
 Rehabilitation & psychosocial
intervention
4

5. Single agent
Acamprosate
 Naltrexone
 Disulfiram
 Aimed at complete abstinence ,
can be started at any time
including withdrawal phase,
 may be started immediately
during first consultation
 Early onset with family loading,
helps in heavy drinking and may be
choice in which acamprosate trial has
failed,
 Liver function test is mandatory
 Patient completely motivated and
with good social support, still low
acceptability

6.  SSRIs (Fluoxetine,
Sertraline, Citalopram)
 Topiramate
 Baclofen
 Effective with co morbid
depression
 Can be used as single
agent, or with co
morbidities like seizure,
bipolar disorder.
 Helpful in withdrawal
management and relapse
prevention in patients with
cirrhosis liver. Also co
morbid cannabis or solvent
or benzodiazepine uses
6

7. General principles of treatment
 Careful monitoring and supportive care
 Ample fluids (p/o or IV fluids if
dehydrated)
 Correction of electrolyte imbalance
 Parenteral Thiamine(100 mg p.o or i.v or
i.m) daily
 Restrict access to addicting substances
 Involve significant others in the treatment
from the initial stages
 Liaise with specialists as appropriate
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8.  Cross tolerant medications with alcohol
 Benzodiazepines
 Diazepam and Chlordiazepoxide
Lorazepam and oxazepam - short acting
(patients with liver
problems, in elderly)
 Others (more than 150 agents,
carbamazepine; valproate, ß adrenergic
antagonists etc.,)
 Emerging: Baclofen
8

9. Ethanol AcetateAcetaldehyde
•Flushing
•Headache
•Palpitations
•Dizziness
•Nausea
ADH ALDH
 .
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Disulfiram

10.  Main contraindications:
recent alcohol use, pregnancy, rubber, nickel
or cobalt allergy, cognitive impairment, drug
interactions
hepatitis, neuropathy
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Disulfiram 250 mg/d-->500 mg/d
Main side effects:

11. Acamprosate (calcium acetyl homo
taurinate)
 structure similar to GABA amino
acid.
 Restores the GABA activity.
 reduce glutamate surges that
excite NMDA- Rs.
 acts as a neuro-protectant and
protect neurons from damage
caused by alcohol withdrawal
11

12. The Reward
Pathway
Ethanol
Dopamine
Beta endorphin
release potentiated
Naltrexone-
aimed at reducing the psychological need or craving for alcohol.
prefrontal cortex
nucleus accumbens
VTA
Firing
12

13. ▪ Main contraindication:
opiates, pregnancy
▪ Main side effects:
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Naltrexone 12.5 mg/d-->25 mg/d-->50 mg/d

14. ▪ a 5-HT3 antagonist that exerts its antidrinking effects
through cortico-mesolimbic dopamine system
modulation.
▪ improve drinking outcomes in patients with early-onset
alcoholism.
▪ Adverse events are mild
▪ starting dosage of 4 mcg/kg twice daily should be
maintained throughout treatment.
14

15. 15

16. Treatment of
 Dependence and Abuse
 Intoxication
 Withdrawal
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17. Naltrexone
 Complete abstinence approach
 long term treatment helps in
maintaining complete abstinence
 extinction of drug seeking behavior
 blocking the effects of opioid over
a significant period
 Reduced craving

18. Advantage
 No tolerance or
withdrawal
 Not a schedule drug
 No abuse potential
Disadvantage
 Abstinence for 5-7
days
 Retention and
compliance issues
 Sensitivity to over
dosages
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19. Methadone
Buprenorphine
LAAM( levo Alfa acetyl methadone)

20. Advantages
 Best available
evidence
 Lower costs
 Good Retention and
abstinence rates
Disadvantages
 Mortality following
overdose
 Scheduled drug
 Supervised clinic
 Daily dosing
 Abuse and dependence
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21.  semi-synthetic opium alkaloid derivative of
thebaine.
 long acting, highly lipophilic opiate
 Mixed agonist antagonist
 Side effects – as in methadone
elevated liver enzymes
 Toxicity – Less risk, none reported
but if occurs, difficult to reverse and needs higher
doses of naloxone
.
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22. THANKYOU
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