研究新知分享
多重藥物濫用/依賴之藥物治療-以藥理及免疫學角度驗證 Memantine 之新適應症
發佈日期：2016/11/24
Authors: 陸汝斌
Contributors: 行為醫學研究所
日期:2009
上傳時間:2011-02-01 17:27:38 (UTC+8)
摘要:
鴉片類(海洛因)依賴目前已嚴重危害社會大眾健康與安全問題，雖然目前美沙冬替代療法可降低犯罪率、提升個人生活品質的效果已被證實，但因病人無法定期且 持續服用美沙冬，導致復發率高居不下。而美沙冬也是另一種鴉片類的長效成癮物質。因此，替代療法對於鴉片類的濫用，其治療效果有限。 Memantine在過往被認為屬於非競爭性N-methyl-D-aspartate (NMDA)接受體的阻斷劑，但近年來發現它對多種神經退化性疾病有神經保護的作用，並能經由其對神經膠細胞之作用抑制腦內發炎反應以及提供神經滋養效 果。回顧以往文獻並發現memantine對多種藥物之成癮行為有抑制作用。這些結果皆顯示合併使用memantine與美沙冬治療成癮行為有其獨特的優 點，並可能優於多年來原有的治療模式。本研究主要目的即為探討memantine經抑制腦內發炎之作用所產生的神經保護功能，合併美沙冬治療多重藥物成癮 患者的療效評估，也可以經由治療的反應從另外一個角度探討成癮行為的多重病因。 本研究利用雙盲隨機、平行分派的方式，預計在兩年的期間，收集200位鴉片類依賴合併安非他命濫用/依賴之18～65歲男、女案例，調整患者所需之美沙冬 劑量隨機分派後，開始進行12週的治療，受試者將接受每天五毫克memantine或安慰劑的治療。治療期間患者將接受多方面評估，包含治療之反應、副作 用、神經生理測驗、各種免疫相關指標等，以清楚瞭解合併使用memantine對於成癮行為之治療效果，亦近一步探討此治療對於鴉片類依賴之社會再適應及 精神病理學的可能益處。
Opioid dependence is currently a severe problem for public health and social security. Methadone maintenance therapy may decrease the criminal rate and increase the quality of life for individuals with opioid dependence, but the high drop-out rate and long-term requirement to use of methadone are major problems in methadone maintenance therapy for opioid dependence. Methadone is after all another long acting opioid which may cause dependence. Therefore, current effort of methadone maintenance therapy is limited. Memantine used to be recognized as a noncompetitive N-methyl-D-aspartate receptor antagonist. It was found with neuroprotective effects in several neurodegenerative diseases in recent few years. Memantine could inhibit brain inflammatory response through its action on reuroglial cells and provide neurotrophic effect. Previous studies also found memantine with inhibitory effects addictive behaviors in several substances. All of the above demonstrated that the combination of memantine and methadone in treating substance dependence prossess unique advantages, which may be superior to the original treatment. The main purpose of this study is to explore the neuroprotective effect of memantine on inhibition of brain inflammatory response through its action on reuroglial cells. Besides, we will evaluate the therapeutic effect of the combination of memantine and methadone in the subjects with opioid combine amphetamine dependence/abuse. It will also investigate multiple pathogenesis of addictive behaviors from the perspective of treatment response. This is a double-blinded, placebo-controlled, randomized, and parallel clinical research trial study. We expect to recruit 200 subjects with opioid combine amphetamine dependence/abuse between 18-65 years of age in 2-year duration. Add-on of memantine or placebo treatment will proceed in a double-blinded fashion for 12 weeks after adjusted methadone dose. During the study, we will evaluate treatment response and adverse effect from multiple dimensions to elucidate the therapeutic effect of add-on memantine on addictive behaviors. It will also explore the possible advantage of this treatment on social re-adaptation and psychopathogenesis of opioid dependence.
來源：成功大學
Contributors: 行為醫學研究所
日期:2009
上傳時間:2011-02-01 17:27:38 (UTC+8)
摘要:
鴉片類(海洛因)依賴目前已嚴重危害社會大眾健康與安全問題，雖然目前美沙冬替代療法可降低犯罪率、提升個人生活品質的效果已被證實，但因病人無法定期且 持續服用美沙冬，導致復發率高居不下。而美沙冬也是另一種鴉片類的長效成癮物質。因此，替代療法對於鴉片類的濫用，其治療效果有限。 Memantine在過往被認為屬於非競爭性N-methyl-D-aspartate (NMDA)接受體的阻斷劑，但近年來發現它對多種神經退化性疾病有神經保護的作用，並能經由其對神經膠細胞之作用抑制腦內發炎反應以及提供神經滋養效 果。回顧以往文獻並發現memantine對多種藥物之成癮行為有抑制作用。這些結果皆顯示合併使用memantine與美沙冬治療成癮行為有其獨特的優 點，並可能優於多年來原有的治療模式。本研究主要目的即為探討memantine經抑制腦內發炎之作用所產生的神經保護功能，合併美沙冬治療多重藥物成癮 患者的療效評估，也可以經由治療的反應從另外一個角度探討成癮行為的多重病因。 本研究利用雙盲隨機、平行分派的方式，預計在兩年的期間，收集200位鴉片類依賴合併安非他命濫用/依賴之18～65歲男、女案例，調整患者所需之美沙冬 劑量隨機分派後，開始進行12週的治療，受試者將接受每天五毫克memantine或安慰劑的治療。治療期間患者將接受多方面評估，包含治療之反應、副作 用、神經生理測驗、各種免疫相關指標等，以清楚瞭解合併使用memantine對於成癮行為之治療效果，亦近一步探討此治療對於鴉片類依賴之社會再適應及 精神病理學的可能益處。
Opioid dependence is currently a severe problem for public health and social security. Methadone maintenance therapy may decrease the criminal rate and increase the quality of life for individuals with opioid dependence, but the high drop-out rate and long-term requirement to use of methadone are major problems in methadone maintenance therapy for opioid dependence. Methadone is after all another long acting opioid which may cause dependence. Therefore, current effort of methadone maintenance therapy is limited. Memantine used to be recognized as a noncompetitive N-methyl-D-aspartate receptor antagonist. It was found with neuroprotective effects in several neurodegenerative diseases in recent few years. Memantine could inhibit brain inflammatory response through its action on reuroglial cells and provide neurotrophic effect. Previous studies also found memantine with inhibitory effects addictive behaviors in several substances. All of the above demonstrated that the combination of memantine and methadone in treating substance dependence prossess unique advantages, which may be superior to the original treatment. The main purpose of this study is to explore the neuroprotective effect of memantine on inhibition of brain inflammatory response through its action on reuroglial cells. Besides, we will evaluate the therapeutic effect of the combination of memantine and methadone in the subjects with opioid combine amphetamine dependence/abuse. It will also investigate multiple pathogenesis of addictive behaviors from the perspective of treatment response. This is a double-blinded, placebo-controlled, randomized, and parallel clinical research trial study. We expect to recruit 200 subjects with opioid combine amphetamine dependence/abuse between 18-65 years of age in 2-year duration. Add-on of memantine or placebo treatment will proceed in a double-blinded fashion for 12 weeks after adjusted methadone dose. During the study, we will evaluate treatment response and adverse effect from multiple dimensions to elucidate the therapeutic effect of add-on memantine on addictive behaviors. It will also explore the possible advantage of this treatment on social re-adaptation and psychopathogenesis of opioid dependence.
來源：成功大學
相關連結1：成功大學