OPIAT BAĞIMLILIĞINDA ANTAGONIST TEDAVİ: NALTREXONE

Ayhan Kalyoncu; Hasan Mırsal; Tulga Satır

OPIAT BAĞIMLILIĞINDA ANTAGONIST TEDAVİ: NALTREXONE

Yazarlar

Ayhan Kalyoncu Balıklı Rum Hastanesi Anatolia Klinikleri
Hasan Mırsal Balıklı Rum Hastanesi Anatolia Klinikleri
Tulga Satır Balıklı Rum Hastanesi Anatolia Klinikleri

Anahtar Kelimeler:

Opiat Bağımlılığı- Antagonist Etken- Bağımlılık tedavisi

Özet

Naltrexone nispeten uzun bir etkileme süresi olan spesifik bir opioid antagonisttir ve opioid bağımlılığının nüksetmesini önlemede yardımcı olarak kullanılabilir. Naltrexone güvenlidir ve bir dereceye kadar toksik değildir. Antagonist tedavi seçeneği, uyuşturucusuz yaşamı arzulayan motivasyonu yüksek bağımlı bireylere elverişli olabilmesi için önem taşır. Bağımlılık tedavisinde kullanılan tüm ilaç tedavilerinde olduğu gibi, naltrexone, bireysel psikoterapi ya da aile psikoterapisi ve kullanımı yasak olan ilaçlar için idrar testleri ile yapılacak kontrolleri içeren geniş kapsamlı bir tedavi programı dahilinde kullanılmalıdır. Tedavi en az 3 ay , hatta bazı vakalarda daha da fazla sürmelidir çünkü nüksetmenin birkaç yıl sürme riski vardır. İlaç tedavilerinin geliştirilmesi konusunda uzmanlar tarafından yürütülen çok sayıda çalışma bulunmakta-dır.Şu anda İncelenmekte olan birkaç ilaç tedavisi önümüzdeki birkaç yıl içinde tedavi seçeneklerine eklenecektir. Son yıllarda 30-60 gün boyunca nüksetmeye karşı koruma sunan naltrexone’un depo türüne ilişkin inceleme sürdürülmektedir. Alkolik denekler üzerinde yapılan yakın tarihli klinik denemeler naltrexone’un ayakta uygulanan bir rehabilitasyon programına dahil edilen alkolik bireyler arasında nüksetme sıklığını azaltabildiğini ortaya koymaktadır.

Kaynaklar

O’Brien, C.P.; Opioid addiction, in Handbook of Experimental Pharmacology. Edited by Herz Akil H, Simon HJ. Berlin, Springer-Verlag, 1992, 803-823-

Greenstein, R.A., Arndt, I.C., McLellan, A.T. et al; Naltrexone: a clinical perspective. J Clin Psychiatry 45:25-28, 1984.

Martin, W., Jasinski, D., Mansky, P. Naltrexone.; an antagonist for the treatment of heroin dependence. Arch Gen Psychiatry 28:784-791, 1973

O’Brien, C.P., Greenstein, R., Mintz, J. et al.; Clinical experience with naltrexone. Am J Drug Alcohol Abuse 2:365-377, 1975.

Ellingboe, J., Mendelson, J.H., Ku-ehnle, J.C.; Effects of heroin and naltrexone on plasma prolactin levels in man. Pharmacol Biochem Behav 12:163-165, 1980.

Mendelson, J.H., Ellingboe, J., Ku-ehnle, J.C. et al.; Heroin and naltrexone effects on pituitary-gonadal hormones in man: interaction of steroid feedback effects, tolerance and supersensitivity. J Pharmacol Exp Ther 214:503-506, 1980.

Spiegel, T., Stunkard, A.J., Shrager, E. et al.; Effect of naltrexone on food intake, hunger, and satiety in obese men. Psysiol Behav 40:135-141,1987.

Brahen, L.S., Henderson, R.K., Copone, T. et al.; Naltrexone treatment in a jail work-release program. J Clin Psychiatry 45:49-52, 1984.

Tennant, E, Rawson, R., Cohen. A. et al.; A clinical experience with naltrexone in suburban opioid addicts. J Clin Psychiatiy 45:42-45, 1984.

Washton, A.M., Pottash, A.C., Gold, M.S.; Naltrexone in addicted business executives and psysicians. J Clin Psychiatry 45:39-41, 1984.

Sideroff, S.I., Charuvastra, V.C., Jarvik, M.E.; Craving in heroin addicts maintained on the opiate antagonist naltrexone. Am J Dmg Alcohol Abuse 5:415-423, 1978.

Meyer, R.E., Mirin, S.M., Altman, J.L.; The clinical usefulness of narcotic antagonists: implications of behavioral research. Am J Drug and Alcohol Abuse. 2:417-432, 1975.

Cornish, J.W., Henson, D.,Levine, S. et al.; Naltrexone maintenance: effect on morphine sensitivity in normal volunteers. American Journal on Addictions 2:34-38, 1993.

Tilly, J., O’Brien, C.P., McLellan, A.T. et al.; Naltrexone in the treatment of federal probationers, in Problems of Drug Dependence 1991, Proceedings of the 53rd Annual Scientific Meeting, The Committee on Problems of Drug Dependence, NIDA Res Monogr 119 (Publ No ADM-92-188). Edited Harris L, Washington, DC, U.S. Goverment Printing Office, 1992, 458.

Pektaş, Ö., Kalyoncu, A., Mirsal, H., Pektaş, A., Şatır, T, Beyazyürek, M.; Different forms (oral and implant) of naltrexone use in relapse prevention on heroin addicts: a controlled clinical trial up to 6 months follow up. American Academy of Addiction Psychiatry , 10 th Annual Meeting and Symposium, December 2-5, 1999, Nassau Marriott Resort, Nassau, Bahamas.

Kalyoncu, A., Şatır, T., Mirsal, H., Pektaş, Ö., Beyazyürek, M.; Naltrexone implant in opiate dependence: sociodemographic variables and evaluation of psychiatric symptoms in the first two months of he first naltrexone implantation. American Academy of Addiction Psychiatry , 10 th Annual Meeting and Symposium, December 2-5, 1999, Nassau Marriott Resort, Nassau, Bahamas.

Pektaş, Ö., Kalyoncu, A., Mirsal, H., Gooberman. L.L., Beyazyürek, M.; Different forms (oral and implant) of naltrexone use in relapse prevention on heroin addicts: a controlled clinical trial up to 6 months follow up (preliminary results). XXI Colllegium Internationale, Neuro-Psycopharmacologicum Congress, July 12-16, 1998, Glosgow, U.K.

Pektaş, Ö., Şatır, T; An overview on naltrexone implant treatment outcomes in Anatolia Clinics for Addiction Treatment. Rapid Opiate Detoxification Under Anesthesia Or Sedation and Post-Detox Management Using Naltrexone. A Two Day International Symposium, June 17-18th 1999, Berlin, Germany.

Hollister, L.; Report of the national research council commitee on clinical evaluation of narcotic antagonists: clinical evaluation of naltrexone treatment of dependent individual. Arch Gen Psychiatry 33:335-340, 1978.

Pfohl, D., Allen, J., Atkinson, R. et al.;Trexan (naltrexone hydrochloride): a review of hepatic toxicityat at high dosage, in Problems of Drug Dependence 1985, NIDA Res Monogr 67 (Publ No ADM-86-1448). Edited by Harris LS. Rockville, MD, U.S. Department of Health and Human Services, 1986, 66-72.

Arndt, I.O., Cacciola, J.S, McLellan, A.T. et al.; A re-evaluation of naltrexone toxicity in recovering opiate addicts, in Problems of Drug Dependence 1985, NIDA Res Monogr 67. Edited by Harris, L.S., Rockville, M.D., U.S.; Department of Health and Human Services, 1986, 525.

Christian, M.A.; Reproductive toxicity and teratology evaluation of naltrexone. J Clin Psychiatry 45:7-10,1984.

Maany, L, O'Brien, C.P., Woody, G.; Interaction between thioridazine and naltrexone (letter). Am J Psychiatiy 144:966, 1987.

Hubbel, C.L., Czirr, S.A., Reid, L.D.; Persistence and specifity of small doses of morphine on intake of alcoholic beverages. Alcohol 4:149-156, 1987.

Reid, L.D., Hunter, G.A.; Morphine and naloxone modulate intake of ethanol. Alcohol 1:33-37, 1984.

DeWitte.; Nalozone reduces alcohol intake in a free-choice procedure even when both drinking bottles contain saccharin sodium or quinine substances. Neuropsychobiology 12:73-77, 1984.

Samson, H.H., Doyle, T.E; Oral ethanol self-administration in the rat:effect of nalozone. Pharmacol Bi-ochem Behav 22:91-99, 1985.

Volpicelli, J.R., Davis, M.A., Olgin, J.E.; Naltrexone blocks the postshock increase of ethanol consumption. Life Sei 38:841-847, 1986.

Volpicelli, J.R., O'Brien, C.P.. Alterman, A.I. et al.; Naltrexone and the treatment of alcohol dependence: initial observations, in Opioids, Bulimia, and Alcohol Abuse and Alcoholism. Edited by Reid LB. New York, Springer-Verlag New York, 1990, 195-214.

Volpicelli, J.R., Alterman, A.I., Hayashida, M. et al.; Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 49:876-880, 1992.

O’Malley, S.S., Jaffe, A., Chang, G. et al; Naltrexone in the treatment of alcohol dependence: preliminary findings, in Novel Pharmacological Interventions for Alcoholism. Edited by Naranjo CA, Sellers EM. New York, Springer-Verlag New York, 1991, 148-157

O’Malley, S.S., Jaffe, A., Chang, G. et al; Naltrexone and coping skills therapy for alcohol dependence: a controlled study. Arch Gen Psychiatry 49:881-887, 1992.

OPIAT BAĞIMLILIĞINDA ANTAGONIST TEDAVİ: NALTREXONE