[Guidelines for the drug therapy of alcoholism]

In acute alcohol intoxication, treatment is symptomatic and consists of correcting any physiological dysfunctions, as possible acid-basic or electrolytic disorders hypoglycemia, hypovitaminosis changes and of maintaining respiratory tracts open. Recently, in some cases of acute intoxication, metadoxine has been used with success, being capable of accelerating the urinary elimination of ethanol and acetaldehyde. Moreover, further studies have shown that Ro 15-4513 (an inverse agonist of benzodiazepine receptors) reduces the anaesthesia time induced by high doses of ethanol in rats. On the other hand, as far as the alcohol withdrawal syndrome is concerned, drugs commonly used are: alcohol itself, chloral hydrate, paraldehyde, barbiturates, chlormetizole and benzodiazepines (administered at high doses). Very recent experiments have been carried out using gammahydroxybutyric acid (GHB), which can produce a rapid and complete suppression of alcohol withdrawal symptoms. In epileptic patients, it is suitable to administer anticonvulsivant drugs together with the above compounds. In alcohol dependence two main treatment strategies are followed, the first is the administration of inhibitory drugs of aldehyde dehydrogenase (disulfiram, calciumcyanamide) which, if given before alcohol consumption, produce unpleasant and avversive reactions, due to the accumulation of acetaldehyde in the blood. Other drugs, recently used with great success, remove the desire to drink without producing those unpleasant reactions described for disulfiram; amongst these are GHB and serotonin uptake inhibitors (fluoxetine, zimelidine).