Naltrexone and Nalmefene: Any Meaningful Difference?

  • Robert M. Swift
    Address correspondence to Robert Swift, M.D., Ph.D., 121 South Main Street, Room 404, Providence, RI 02906
    Center for Alcohol and Addiction Studies, Brown University Alpert School of Medicine, and Providence VA Medical Center, Providence, Rhode Island
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      In this issue of Biological Psychiatry, Mann and colleagues (
      • Mann K.
      • Bladström A.
      • Torup L.
      • Gual A.
      • van den Brink W.
      Extending the treatment options in alcohol dependence: A randomized controlled study of as-needed nalmefene.
      ) report the results of a double-blind placebo-controlled clinical trial of the opioid antagonist nalmefene in the treatment of 598 alcohol-dependent participants drinking at a moderate or greater alcohol risk level according to the World Health Organization criteria for alcohol risk. The study used a somewhat different design in that the medication (20 mg nalmefene or placebo) was taken in a targeted or “as-needed fashion,” that is, on days when participants perceived that they were at high risk for drinking. All participants received BRENDA, a psychosocial therapy designed to enhance medication adherence and to provide psychological support during treatment. In this article, I discuss the study findings in light of what is known about opioid antagonists and alcohol dependence and compare and contrast the medication used in this study, nalmefene, with the better known and more widely used opioid antagonist naltrexone.
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        • Mann K.
        • Bladström A.
        • Torup L.
        • Gual A.
        • van den Brink W.
        Extending the treatment options in alcohol dependence: A randomized controlled study of as-needed nalmefene.
        Biol Psychiatry. 2013; 73: 706-713
        • Garbutt J.C.
        Efficacy and tolerability of naltrexone in the management of alcohol dependence.
        Curr Pharm Des. 2010; 16: 2091-2097
        • Walker B.M.
        • Valdez G.R.
        • McLaughlin J.P.
        • Bakalkin G.
        Targeting dynorphin/kappa opioid receptor systems to treat alcohol abuse and dependence.
        Alcohol. 2012; 46: 359-370
      1. Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al., for the COMBINE Study Research Group, (2006): Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. JAMA 295:2003–2017

        • Mason B.J.
        • Ritvo E.C.
        • Morgan R.O.
        • Salvato F.R.
        • Goldberg G.
        • Welch B.
        • Mantero-Atienza E.
        A double-blind, placebo-controlled pilot study to evaluate the efficacy and safety of oral nalmefene HCl for alcohol dependence.
        Alcohol Clin Exp Res. 1994; 18: 1162-1167
        • Anton R.F.
        • Pettinati H.
        • Zweben A.
        • Kranzler H.R.
        • Johnson B.
        • Bohn M.J.
        • et al.
        A multi-site dose ranging study of nalmefene in the treatment of alcohol dependence.
        J Clin Psychopharmacol. 2004; 24: 421-428
        • Rösner S.
        • Leucht S.
        • Lehert P.
        • Soyka M.
        Acamprosate supports abstinence, naltrexone prevents excessive drinking: Evidence from a meta-analysis.
        J Psychopharmacol. 2008; 22: 11-23
        • Kline-Simon A.H.
        • Falk D.E.
        • Litten R.Z.
        • Mertens J.R.
        • Fertig J.
        • Ryan M.
        • Weisner C.M.
        Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders.
        Alcohol Clin Exp Res. 2013; 37: E373-E380
        • Kranzler H.R.
        • Tennen H.
        • Armeli S.
        • Chan G.
        • Covault J.
        • Arias A.
        • Oncken C.
        Targeted naltrexone for problem drinkers.
        J Clin Psychopharmacol. 2009; 29: 350-357
        • Karhuvaara S.
        • Simojoki K.
        • Virta A.
        • Rosberg M.
        • Löyttyniemi E.
        • Nurminen T.
        • et al.
        Targeted nalmefene with simple medical management in the treatment of heavy drinkers: A randomized double-blind placebo-controlled multicenter study.
        Alcohol Clin Exp Res. 2007; 31: 1179-1187

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