Variability of response to pharmacotherapy of naltrexone and guanfacin in patients with opioid dependence syndrome: pharmacogenetic aspect

Abstract

There is a problem of insufficient effectiveness of pharmacotherapy for the relapse prevention in patients with opioid dependence. In Russian Federation naltrexone is a mainly used medication for treatment of opioid addiction. However, it has no effects on stress, craving, and impulsiveness. Alpha-2 adrenoreceptor agonists can reduce the severity of these symptoms and thus might improve effectiveness of naltrexone treatment. Pharmacogenetic analysis is useful for determining potential responders and nonresponders to the treatment of opioid dependence. The aim of this study was to evaluate the variability of response to pharmacotherapy of naltrexone and guanfacin in patients with opioid dependence syndrome. This was a multicenter, randomized, double-blind, placebo-controlled clinical trial using a pharmacogenetic approach. The good tolerability and safety of naltrexone and guanfacine combination with long-term course treatment for stabilization of remission of opioid dependence was scientifically substantiated. Was showed a moderate stress-protective and anti-craving effect of guanfacin in the period of early remission with opioid dependence syndrome. Genetic analysis is useful for determining potential responders to the treatment of opioid dependence, genotyping can increase effectiveness of pharmacotherapy.

Keywords

• opioid addiction, remission, remission stabilization, naltrexone, guanfacin, pharmacogenetics