Anti-addiction agents

Pharmacotherapeutic interventions for addiction focus on treatment and prevention of dependence. Addiction is a complex biological process and its complete underlying pathophysiology remains elusive. Successful treatment involves both short-term and long-term maintenance pharmacologic approaches linked with various psychosocial support avenues. However, specific agents have been developed for alcohol, nicotine, and opiate dependence. Disulfiram has been used since the 1950s as an aversive therapeutic technique where its metabolites when exposed to alcohol lead to the patient experiencing symptoms of nausea and vomiting, encouraging the patient to abstain from alcohol. Acamprosate is indicated for alcohol abstinence maintenance with the chemical component acetyl-homotaurine measured in pharmacokinetic studies. Acamprosate is primarily renally excreted. Varenicline is a partial agonist of the central nicotinic acetylcholine receptor and approved for the treatment of nicotine dependence. Varenicline is mainly renally excreted where a combined pharmacokinetic-pharmacodynamic model described this compound with an open two-compartment pharmacokinetic model with a linear pharmacodynamic model. Naloxone and naltrexone are opiate antagonists used in a variety of clinical settings. Naloxone is a "rescue" agent for opiate overdose. Naltrexone is used for alcohol dependence and available in an oral and a monthly long-acting depot injection. Naloxone has been combined with pentazocine, buprenorphine, and oxycodone to prevent abuse. Levo-alpha acetyl methadol (LAAM) is a potent derivative of methadone but QTc prolongation occurrences have limited its clinical use.