TIAPRIDE - A REVIEW OF ITS PHARMACOLOGY AND THERAPEUTIC POTENTIAL IN THE MANAGEMENT OF ALCOHOL DEPENDENCE SYNDROME

Tiapride, an atypical neuroleptic agent, is a selective dopamine D-2-r eceptor antagonist with little propensity for causing catalepsy and se dation. It shows preferential activity at receptors previously sensiti sed to dopamine and those located extrastriatally. Tiapride demonstrat es antidyskinetic activity reflecting antidopaminergic actions, and al so anxiolytic activity mediated by mechanisms that are poorly understo od. Unlike the benzodiazepines, tiapride does not affect vigilance and has a low potential for interaction with alcohol (ethanol), and possi bly for abuse. Tiapride facilitates management of alcohol withdrawal, but its use in patients at risk of severe reactions in acute withdrawa l should be accompanied by adjunct therapy for hallucinosis and seizur es. Since it may prove difficult to identify such patients and there i s also a small risk of neuroleptic malignant syndrome (particularly wi th parenteral administration), the usefulness of tiapride in this sett ing is likely to be limited. Nevertheless, relative freedom from the c omplications associated with benzodiazepine therapy suggest a possible role for the drug in the treatment of individuals suitable for alcoho l detoxification as outpatients. Preliminary clinical studies in alcoh olic patients following detoxification have shown that tiapride amelio rates psychological distress, improves abstinence, and reduces drinkin g behaviour, and in the short term facilitates reintegration within so ciety. These benefits were associated with reduced consumption of heal th care resources. However, the potential risk of tardive dyskinesia a t the dosage employed (300 mg/day) requires evaluation and necessitate s medical supervision. Thus, with its lack of adverse effects on vigil ance and low propensity for interaction with alcohol and possibly for abuse, tiapride will probably find particular use in the management of alcoholic patients suitable for detoxification in an outpatient setti ng; and, if initial findings are confirmed in large well-designed tria ls, in the short term (less than or equal to 6 months) therapy of refo rmed alcoholic patients under medical supervision.