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Aubin HJ. Repurposing drugs for treatment of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:153-185. [PMID: 38555115 DOI: 10.1016/bs.irn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Repurposing drugs for the treatment of alcohol dependence involves the use of drugs that were initially developed for other conditions, but have shown promise in reducing alcohol use or preventing relapse. This approach can offer a more cost-effective and time-efficient alternative to developing new drugs from scratch. Currently approved medications for alcohol use disorder (AUD) include acamprosate, disulfiram, naltrexone, nalmefene, baclofen, and sodium oxybate. Acamprosate was developed specifically for AUD, while disulfiram's alcohol-deterrent effects were discovered incidentally. Naltrexone and nalmefene were originally approved for opioids but found secondary applications in AUD. Baclofen and sodium oxybate were repurposed from neurological conditions. Other drugs show promise. Topiramate and zonisamide, anticonvulsants, demonstrate efficacy in reducing alcohol consumption. Another anticonvulsant, gabapentin has been disappointing overall, except in cases involving alcohol withdrawal symptoms. Varenicline, a nicotinic receptor agonist, benefits individuals with less severe AUD or concurrent nicotine use. Ondansetron, a 5-HT3 antagonist, has potential for early-onset AUD, especially when combined with naltrexone. Antipsychotic drugs like aripiprazole and quetiapine have limited efficacy. Further investigation is needed for potential repurposing of α1 adrenergic receptor antagonists prazosin and doxazosin, glucocorticoid receptor antagonist mifepristone, the phosphodiesterase inhibitor Ibudilast, the cysteine prodrug N-acetylcysteine, and the OX1R and OX2R blocker Suvorexant. This review supports repurposing drugs as an effective strategy for expanding treatment options for AUD.
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Affiliation(s)
- Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France.
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Abstract
Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all individuals with an AUD. As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. In this qualitative literature review, we discuss the efficacy, mechanism of action, and tolerability of approved, repurposed, and novel pharmacotherapies for the treatment of AUD with a clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, and cannabidiol. Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. Importantly, these medications also offer potential improvements towards the advancement of precision medicine and personalized treatment for the heterogeneous AUD population. However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD.
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Libarino-Santos M, Brandão NRN, Borges ÁLN, Anjos-Santos A, Cata-Preta EG, Barros-Santos T, Oliveira-Campos D, Brito ACL, Oliveira TS, Kisaki ND, Silva AAF, Cruz FC, Berro LF, Marinho EAV, Oliveira-Lima AJ. Aripiprazole and topiramate, alone or in combination, block the expression of ethanol-induced conditioned place preference in mice. Drug Alcohol Depend 2021; 220:108520. [PMID: 33485011 DOI: 10.1016/j.drugalcdep.2021.108520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ethanol is the most largely consumed drug in the world. Because of its complex mechanisms of action, studies suggest that the combination of drugs with distinct pharmacological effects may be a promising alternative for treating ethanol use disorder. In the present study, we aimed to investigate the effects of topiramate, alone and in combination with aripiprazole, on ethanol-induced conditioned place preference (CPP). METHODS Adult male mice were conditioned with ethanol (1.8 g/kg, i.p.) in the conditioned place preference (CPP) apparatus. Animals were then treated with vehicle, topiramate (2.5, 5 or 10 mg/kg, i.p.), aripiprazole (0.025, 0.05, 0.075 or 0.1 mg/kg, i.p.) or a combination of subthreshold doses of topiramate and aripiprazole (5 and 0.075 mg/kg, respectively) in the ethanol-paired compartment for 8 consecutive days. The expression of ethanol-induced CPP was then evaluated during a drug-free test performed 24 h after a re-exposure to ethanol in the ethanol-paired compartment. RESULTS Treatment with 10 mg/kg topiramate or 0.1 mg/kg aripiprazole blocked the expression of ethanol-induced CPP. Combined treatment with 5 mg/kg topiramate and 0.075 mg/kg aripiprazole, doses that alone were not effective, also blocked the expression of CPP to ethanol. CONCLUSIONS Topiramate and aripiprazole, alone or in combination, blocked the expression of ethanol-induced CPP. By showing that a combination of lower, subthreshold doses or topiramate and aripiprazole was effective in blocking the conditioned reinforcing properties of the ethanol-paired environment in mice, our current findings provide important insights into the therapeutic use of these drugs in ethanol use disorder.
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Affiliation(s)
- Matheus Libarino-Santos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Nina R N Brandão
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Áurea L N Borges
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Alexia Anjos-Santos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Elisângela G Cata-Preta
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Thaísa Barros-Santos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Daniella Oliveira-Campos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Ana Carolina L Brito
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Thaynara S Oliveira
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Natali D Kisaki
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Aline A F Silva
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Fabio C Cruz
- Department of Pharmacology, São Paulo Federal University, Leal Prado Building, Botucatu 862 Street, 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | - Laís F Berro
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil; Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA.
| | - Eduardo A V Marinho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Alexandre J Oliveira-Lima
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil.
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Effects of the monoamine stabilizer, (-)-OSU6162, on cocaine-induced locomotion and conditioned place preference in mice. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1143-1152. [PMID: 33471153 DOI: 10.1007/s00210-021-02053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Cocaine addiction is a severe mental disorder for which few treatment options are available. The underlying mechanisms include facilitation of monoamine-neurotransmission, particularly dopamine. Here, we tested the hypothesis that the monoamine stabilizers, (-)-OSU6162 ((3S)-3-(3-methylsulfonylphenyl)-1-propylpiperidine) and aripiprazole (7-[4-[4-(2,3-dichlorophenyl)piperazin-1-yl]butoxy]-3,4-dihydro-1H-quinolin-2-one), prevent cocaine-induced behaviors. Male Swiss mice received injections of (-)-OSU6162 or aripiprazole and cocaine and were tested for cocaine-induced hyperlocomotion, locomotor sensitization, and acquisition and expression of conditioned place preference (CPP). The increase in the distance traveled induced by cocaine (20 mg/kg) was prevented by pretreatment with aripiprazole (1 and 10 mg/kg), whereas (-)-OSU6162 (3 mg/kg) exerted a minor effect. Aripiprazole, however, also impaired spontaneous locomotion. Neither (-)-OSU6162 nor aripiprazole interfered with the locomotor sensitization and expression of CPP induced by cocaine (15 mg/kg). (-)-OSU6162 (3 mg/kg), but not aripiprazole, prevented the acquisition of CPP induced by cocaine (15 mg/kg). (-)-OSU6162 exerts a minor effect in reducing cocaine-induced stimulatory activity and context-related memories, which are responsible for triggering drug seeking. Further studies are required to establish whether (-)-OSU6162 could be a candidate drug for the treatment of cocaine addiction.
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Kimbrough A, de Guglielmo G, Kononoff J, Kallupi M, Zorrilla EP, George O. CRF 1 Receptor-Dependent Increases in Irritability-Like Behavior During Abstinence from Chronic Intermittent Ethanol Vapor Exposure. Alcohol Clin Exp Res 2017; 41:1886-1895. [PMID: 28833238 DOI: 10.1111/acer.13484] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND In humans, emotional and physical signs of withdrawal from ethanol are commonly seen. Many of these symptoms, including anxiety-like and depression-like behavior, have been characterized in animal models of ethanol dependence. One issue with several current behavioral tests that measure withdrawal in animal models is that they are often not repeatable within subjects over time. Additionally, irritability, one of the most common symptoms of ethanol withdrawal in humans, has not been well characterized in animal models. The corticotropin-releasing factor (CRF)-CRF1 receptor system has been suggested to be critical for the emergence of anxiety-like behavior in ethanol dependence, but the role of this system in irritability-like behavior has not been characterized. METHODS The present study compared the effects of chronic intermittent ethanol (CIE) vapor exposure-induced ethanol dependence on irritability-like behavior in rats using the bottle-brush test during acute withdrawal and protracted abstinence. Rats were trained to self-administer ethanol in operant chambers and then either left in a nondependent state or made dependent via CIE. Naïve, nondependent, and dependent rats were tested for irritability-like behavior in the bottle-brush test 8 hours and 2 weeks into abstinence from ethanol. Separate cohorts of dependent and nondependent rats were used to examine the effect of the specific CRF1 receptor antagonist R121919 on irritability-like behavior. RESULTS Dependent rats exhibited escalated ethanol intake compared with their own pre-CIE baseline and nondependent rats. At both time points of abstinence, ethanol-dependent rats exhibited increased aggressive-like responses compared with naïve and nondependent rats. R121919 reduced irritability-like behavior in both dependent and nondependent rats, but dependent rats were more sensitive to R121919. CONCLUSIONS Irritability-like behavior is a clinically relevant and reliable measure of negative emotional states that is partially mediated by activation of the CRF-CRF1 system and remains elevated during protracted abstinence in ethanol-dependent rats.
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Affiliation(s)
- Adam Kimbrough
- Department of Neuroscience (AK, GdG, JK, MK, EPZ, OG), The Scripps Research Institute, La Jolla, California
| | - Giordano de Guglielmo
- Department of Neuroscience (AK, GdG, JK, MK, EPZ, OG), The Scripps Research Institute, La Jolla, California
| | - Jenni Kononoff
- Department of Neuroscience (AK, GdG, JK, MK, EPZ, OG), The Scripps Research Institute, La Jolla, California
| | - Marsida Kallupi
- Department of Neuroscience (AK, GdG, JK, MK, EPZ, OG), The Scripps Research Institute, La Jolla, California
| | - Eric P Zorrilla
- Department of Neuroscience (AK, GdG, JK, MK, EPZ, OG), The Scripps Research Institute, La Jolla, California
| | - Olivier George
- Department of Neuroscience (AK, GdG, JK, MK, EPZ, OG), The Scripps Research Institute, La Jolla, California
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Martinotti G, Orsolini L, Fornaro M, Vecchiotti R, De Berardis D, Iasevoli F, Torrens M, Di Giannantonio M. Aripiprazole for relapse prevention and craving in alcohol use disorder: current evidence and future perspectives. Expert Opin Investig Drugs 2016; 25:719-28. [DOI: 10.1080/13543784.2016.1175431] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhao Z, Kim SC, Zhao R, Wu Y, Zhang J, Liu H, Kim YW, Zhu X, Gu C, Lee CW, Lee BH, Jang EY, Ko HL, Yang CH. The tegmental–accumbal dopaminergic system mediates the anxiolytic effect of acupuncture during ethanol withdrawal. Neurosci Lett 2015; 597:143-8. [DOI: 10.1016/j.neulet.2015.04.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/20/2015] [Accepted: 04/27/2015] [Indexed: 11/15/2022]
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Moreira FA, Dalley JW. Dopamine receptor partial agonists and addiction. Eur J Pharmacol 2015; 752:112-5. [DOI: 10.1016/j.ejphar.2015.02.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/04/2015] [Accepted: 02/16/2015] [Indexed: 11/30/2022]
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The antipsychotic aripiprazole selectively prevents the stimulant and rewarding effects of morphine in mice. Eur J Pharmacol 2014; 742:139-44. [DOI: 10.1016/j.ejphar.2014.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 01/23/2023]
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De Deyn PP, Drenth AFJ, Kremer BP, Oude Voshaar RC, Van Dam D. Aripiprazole in the treatment of Alzheimer's disease. Expert Opin Pharmacother 2013; 14:459-74. [PMID: 23350964 DOI: 10.1517/14656566.2013.764989] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Psychosis is a common and difficult to treat symptom in Alzheimer's disease (AD). It is a cause of diminished quality of life and caregiver distress. Atypical antipsychotics are frequently used for the treatment of dementia-related psychosis, despite FDA warnings because of increased mortality associated with the use of these medications in dementia patients. Aripiprazole is a newer atypical antipsychotic drug with partial agonist activity at dopamine receptors and antagonist activity at 5-HT(2A) receptors, with a low side-effect profile. AREAS COVERED This descriptive review gives a short overview of the pathology and epidemiology of AD, including psychotic symptoms, and describes the mode of action of aripiprazole and results of preclinical studies. Finally, randomized controlled trials evaluating the use of aripiprazole in AD-related psychosis and agitation are discussed. Whenever relevant, meta-analytical data from literature are referred to. EXPERT OPINION In randomized placebo-controlled clinical trials, aripiprazole shows modest efficacy in the treatment of AD-related psychosis. Neuropsychiatric symptoms alleviated were predominantly psychotic features and agitation. In individual trials, aripiprazole was generally well tolerated, serious side effects were seldom reported and included accidental injury and somnolence. Meta-analyses however demonstrated increased mortality as a class effect for atypical, but also for typical antipsychotics. No increased cardiovascular outcomes, cerebrovascular accidents, increased appetite or weight gain were demonstrated in meta-analyses for aripiprazole-treated patients with psychosis of dementia. Aripiprazole was found to induce sedation. Aripiprazole should only be used in selected patient populations resistant to non-pharmacological treatment with persisting or severe psychotic symptoms and/or agitation, and in which symptoms lead to significant morbidity, patient suffering and potential self-harm. The indication for continuing treatment should be revised regularly.
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Affiliation(s)
- Peter Paul De Deyn
- University of Groningen, University Medical Center Groningen, Alzheimer Research Center, Department of Neurology, 9713 GZ Groningen, The Netherlands.
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Ameliorating effects of aripiprazole on cognitive functions and depressive-like behavior in a genetic rat model of absence epilepsy and mild-depression comorbidity. Neuropharmacology 2013; 64:371-9. [DOI: 10.1016/j.neuropharm.2012.06.039] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/14/2012] [Accepted: 06/18/2012] [Indexed: 01/01/2023]
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Kurokawa K, Mizuno K, Shibasaki M, Higashioka M, Oka M, Hirouchi M, Ohkuma S. Acamprosate Suppresses Ethanol-Induced Place Preference in Mice With Ethanol Physical Dependence. J Pharmacol Sci 2013; 122:289-98. [DOI: 10.1254/jphs.13056fp] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Viana TG, Almeida-Santos AF, Aguiar DC, Moreira FA. Effects of aripiprazole, an atypical antipsychotic, on the motor alterations induced by acute ethanol administration in mice. Basic Clin Pharmacol Toxicol 2012; 112:319-24. [PMID: 23157340 DOI: 10.1111/bcpt.12036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/31/2012] [Indexed: 11/30/2022]
Abstract
Aripiprazole is an antipsychotic that acts as a partial agonist at dopamine receptors. As the effects of most drugs of abuse converge to enhance dopamine-mediated neurotransmission, the present study was designed to test the hypothesis that aripiprazole would inhibit the acute effects of ethanol, a widely abused substance. Male Swiss mice received acute injections and were evaluated for motor activity in three distinct tests. In the open field, ethanol (1.5, 2.5 and 3.5 g/kg) induced an increase in locomotion in a U-shaped dose-related fashion, whereas aripiprazole (0.1, 1 and 10 mg/kg) did not affect this parameter. All the doses of the antipsychotic were able to prevent the stimulant effects of 2.5 g/kg of ethanol. In the rotarod test, ethanol (2.5 and 3.5 g/kg) reduced the latency to fall from the apparatus, an effect also observed with the higher dose of aripiprazole. Contrary to what was observed in the open field, this antipsychotic did not interfere with the effects of ethanol in motor balance. Finally, we tested animals in the wire hang test, in which ethanol, but not aripiprazole, reduced latency to fall at all doses. In this test, aripiprazole did not change ethanol effects. The present data lead to the conclusion that aripiprazole prevents the stimulant effects of ethanol on locomotion, without interfering with the motor impairment induced by this drug.
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Affiliation(s)
- Thercia G Viana
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Minas Gerais (Universidade Federal de Minas Gerais), Belo Horizonte, MG, Brazil
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