A Pilot Double-Blind Treatment Trial of Memantine for Alcohol Dependence


Alcoholism: Clinical and Experimental Research (OnlineEarly Articles).
22 March 2007

• Suzette M. Evans^1,2
• ¹New York State Psychiatric Institute, New York, New York;
  
• ²Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York,
• Frances R. Levin^1,2
• ¹New York State Psychiatric Institute, New York, New York;
  
• ²Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York,
• Daniel J. Brooks¹
• ¹New York State Psychiatric Institute, New York, New York; , and
• Fatima Garawi¹
• ¹New York State Psychiatric Institute, New York, New York;

• ¹New York State Psychiatric Institute, New York, New York; ²Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York

This research was supported by NIAAA Grant R01 AA12599 and KO2 00465. We want to thank the staff of the Substance Treatment and Research Service (STARS) of the New York State Psychiatric Institute for their medical, clinical, and research support.

Reprint requests: Suzette M. Evans, PhD, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 66, New York, NY 10032; Fax: 212-543-6018; E-mail: se18@columbia.edu

Abstract

Background:

There is growing evidence that N-methyl-d-aspartate (NMDA) receptor antagonists may have potential for the treatment of alcohol disorders. Memantine is a selective noncompetitive NMDA receptor antagonist that has been shown to decrease alcohol craving in moderate drinkers.

This 16-week double-blind outpatient pilot clinical trial determined if memantine was more effective than placebo at reducing alcohol use in actively drinking alcohol-dependent patients.

Methods:

Forty-four treatment-seeking alcohol-dependent individuals were enrolled, with 34 patients stratified to either the memantine group (n=19; maximum dose of 40 mg/d) or the placebo (PBO; n=15) group.

The primary outcome measures were related to alcohol use (average drinks per day, average drinks per drinking day, percentage of heavy drinking days, and percentage of days abstinent) based on the timeline follow-back (TLFB).

Secondary outcome measures included the Obsessive Compulsive Drinking Scale, Clinical Global Impression ratings, and γ-glutamyltransferase (GGT), a biomarker of recent alcohol use.

To enhance retention, patients received voucher incentives for clinic attendance.

Results:

Of those randomized, approximately 80% (27) completed the entire 16-week trial.

Longitudinal analysis of drinks per day and drinks per drinking day showed a significant reduction in alcohol use, but no difference between the 2 groups. Further, the percentage of heavy drinking days indicated that both groups showed a significant decrease in drinking behavior, but there was significant treatment effect in favor of the PBO group.

Similarly, for the percentage of days abstinent, the PBO group achieved a significantly greater percentage of days abstinent at a faster rate than the memantine group.

Lastly, the memantine group reported a greater number of side effects compared with the PBO group, such that 26% of patients had their drug dose decreased or discontinued due to memantine-related side effects.

Conclusions:

The results of this double-blind placebo-controlled pilot trial do not support the use of memantine for the treatment of actively drinking alcohol-dependent patients.

However, voucher incentives did facilitate retention.