Table 2.
Summary of pharmacotherapeutics for drug addiction
| Drugs of abuse | Medications | Class | Action | Consequences/clinical implications | FDA approved? (±) | Indications/remarks | References |
|---|---|---|---|---|---|---|---|
| Alcohol | Naltrexone | Opioid receptor antagonist | Blocks mu-opioid receptors | Not effective in all patients | + | Less effective against stress-induced relapse | [126–130] |
| Disulfiram | ALDH inhibitor | Inhibits ALDH and prevents acetaldehyde metabolism | Low compliance due to aversive reactions and other side effects | + | Effective against alcohol and cocaine dependence | [100, 127, 129–132] | |
| Acamprosate | NMDA glutamate receptor antagonist | Normalizes hyperglutamatergic states | Adverse reactions e.g., diarrhea, suicidal ideation | + | Reduces withdrawal symptoms and prevents relapse | [127, 130, 131, 133, 134] | |
| Topiramate, Ondansetron and Baclofen | − | Have promising therapeutic potential | [130, 133, 135, 136] | ||||
| Cocaine | NAC | Thiol antioxidant | Regulates X(c) system activity and GSH biosynthesis | Reduces respiratory burst and may cause liver damage | − | Low bio-distribution | [137–139] |
| Modafinil | GABA/glutaminergic agent | Upregulates brain glutamate system | Causes euphoria | − | Approved for other indications | [127] | |
| Topiramate | Antiepileptic drug | Mainly antagonizes AMPA receptors and kainate glutamate receptors | Causes anorexia, paresthesia, reversible cognitive impairment and taste aversion | − | Approved for other indications | [127, 135, 136] | |
| Baclofen, Propranolol, α-adrenergic agonists and Rimonabant | − | Have promising therapeutic potential | [127, 140–142] |
Drug addiction, also called substance use disorder, is generally considered a brain disease. It is measured on a continuum scale that ranges from mild to severe. According to SAMHSA, diagnosis using DSM-5 criteria is based on evidence of social and control impairments, risky use, and pharmacological implications [143]. However, treatment approaches should involve biological, behavioural, and social context components [144] to produce effective results
X(c) system cystine–glutamate antiporter system, NAC N-acetylcysteine, GSH glutathione, DA dopamine, ALDH aldehyde dehydrogenase, AMPA alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid, NMDA N-methyl-d-aspartate, FDA food and drug administration, ± yes/no, DSM-5 diagnostic and statistical manual of mental disorders 5, SAMHSA substance abuse and mental health services administration