Naltrexone and nalmefene: Any meaningful difference?

摘要

In this issue of Biological Psychiatry, Mann and colleagues (1) 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.