DOSING ISSUES IN THE PHARMACOTHERAPY OF ALCOHOLISM

Pharmacological treatments for alcohol dependence have focused increas ingly on agents that reduce alcohol craving and consumption or that tr eat psychiatric disorders associated with drinking relapse. Clinicians who treat alcohol-dependent patients must find the optimal dose of th ese agents to maximize response. Determining the best dosing strategy has been the goal of recent treatment studies with alcohol-dependent p atients. One study, for example, showed that an opiate antagonist medi cation had a dose-dependent relationship with patient outcome and rete ntion in treatment. Another dosing consideration involves the effect o f long-term alcohol abuse on drug metabolism (e.g., when treating alco hol-dependent patients for comorbid psychiatric disorders). This was d emonstrated in a study of recently abstinent patients who were taking the antidepressant desipramine for major depression. Alcohol-dependent patients had higher hepatic enzyme activities and lower plasma levels of desipramine relative to oral dose than did a comparison group of d epressed patients without an alcohol use disorder.