A drug currently approved for the treatment of nausea in cancer patients may help the hardest-to-treat alcoholics reduce their alcohol consumption by decreasing their alcohol cravings. However, it may never be available in the correct dosages for treating alcoholism.
One of the groups of problem drinkers who are difficult to treat successfully are those known as early-onset alcoholics – those who develop alcohol use disorders before they are 25 years old. It is believed that this group has a biological predisposition to alcoholism with a strong family history of alcoholism.
Early onset alcoholics are generally only resistant to behavioral therapies, possibly because they have an imbalance between two chemical “messengers” in the brain, serotonin and dopamine. Scientists believe that this imbalance creates alcohol cravings.
A high rate of relapse among alcoholics on the early set
There are numerous studies showing serotonin dysfunction in early onset alcoholics.
Early-onset alcoholics, according to the National Institute on Alcohol Abuse and Alcoholism, have “a greater family history of alcoholism, an increased propensity for antisocial behavior, and a more stable and more severe illness than those with late-onset alcoholism”.
Early-onset alcoholics have historically not been given advice, show antisocial behavior, and have a high relapse rate when trying to stop drinking.
I am looking for a pharmaceutical solution
Because this group does not respond well to behavior therapy alone, researchers have looked for drugs to treat their chemical imbalance.
One of the drugs that has been repeatedly found to reduce cravings in alcoholics who are biologically predisposed to alcoholism is ondansetron, an FDA-approved drug used to treat nausea in cancer patients. It is marketed under the brand name Zofran.
Several studies with groups of early-onset alcoholics who treated a group with ondansetron and a control group with placebo have found that the drug helps reduce alcohol cravings.
Ondansetron reduces food cravings and drinking days
A study at the University of Texas Health Science Center at San Antonio of 271 patients identified as early onset alcoholics found that ondansetron dosing for 11 weeks resulted in fewer drinks per day and more days without alcohol, compared to the control group.
Another study compared how well ondansetron reduced cravings for early onset alcoholics to what is known as late onset alcoholics – those who developed alcohol use disorders after age 25 and late-onset alcoholics.
Drugs that modulate the dopamine system
Previous studies have shown that drugs that modulate the activity of the brain’s dopamine system by affecting the nerve pathways change drinking behavior. These drugs include ondansetron, naltrexone, topiramate, and baclofen.
An eight-week study found that the combination of ondansetron and naltrexone significantly reduced alcohol consumption in the drug group compared to the placebo controls.
Few side effects with ondansetron
All of the studies with ondansetron found that all of the drug’s side effects are mild. The most commonly reported side effects were constipation, headache, and sedation.
However, one of the problems with treating alcoholics with ondansetron is that the amount of drug used in all clinical trials was much less than the dosage used to treat nausea in cancer patients.
Not commercially available for the treatment of alcoholism
The drug is not commercially available at the therapeutic treatment dose for alcoholism, but only at the higher dose for the treatment of chemotherapy-induced nausea outside of research treatment settings.
One study tried to determine whether the dosage used to treat nausea was appropriate for treating alcoholism, but it was unsuccessful. The researchers concluded, “It appears that the optimal dosage for treating alcoholism has not yet been determined.”
Although research shows ondansetron to be an effective treatment for early onset alcoholics, FDA approval for this indication has been reported for years.
While Ondansetron has not received FDA approval, the drug Campral has been approved for treating alcoholism by reducing cravings.
Since ondansetron has been in the market long enough to now be available in generic form, it would likely not be financially feasible for the manufacturer to seek approval for a lower-dose version for the treatment of alcohol use disorders.