Also, the patient’s medical condition may necessitate lower antidepressant doses. Particular attention should be paid to anticholinergic and cardiovascular adverse effects. The use of tricyclic compounds may be limited by the occurrence of hepatic and myocardial abnormalities In alcoholic patients. Also, the pharmacokinetics of the drug may be changed In the alcoholic. For Instance, Imipramlne clearance Is Increased In the alcoholic, its half -life

Is shortened, and much lower plasma levels will be observed.25 The choice of medication Is likely to be determined by the availability of various classes of drugs, which differs between countries. Serotonergic drugs have been extensively studied Inhibitors,research,lifescience,medical in depressive alcoholics and they have proven effective In maintaining abstinence. They may, therefore, be a useful adjuvant In the therapy of alcoholism. Selective serotonin reuptake Inhibitors (SSRIs) seem to have short-term effects in Inhibitors,research,lifescience,medical alcohol dependence, and are probably more effective In men and In the presence of comorbid depression.26 Citalopram27 was shown to decrease alcohol consumption in nondepressed subjects with alcohol dependence. Fluoxetine28 at antidepressant doses was able to prevent relapses In weaned alcoholics. Trazodone,29 a relatively selective inhibitor

of 5-HT reuptake, was able at low doses to significantly decrease craving for alcohol In detoxified alcohol-dependent Inhibitors,research,lifescience,medical subjects. TIaneptlne,30 a compound that increases 5-HT reuptake, was shown Inhibitors,research,lifescience,medical to be particularly suitable In depressed patients after withdrawal from alcohol abuse or dependence, because of Its relative lack of sedative, anticholinergic, and cardiovascular effect. Viloxazine,31 an inhibitor of norepinephrine reuptake, was shown to be superior to placebo on the reduction of alcohol

consumption. Besides antidepressants, some studies Investigated the effect of mood-regulating agents. Overall, little benefit was found with lithium, whereas valproate seemed more promising. Recently, acamprosate has been Introduced Inhibitors,research,lifescience,medical as a clinical treatment to reduce relapse In Purmorphamine recovering alcoholics In Europe, while naltrexone has been approved for a similar use by the US Food and Drug Administration. CYTH4 Acamprosate exerts agonist-like effects at GABA receptors and antagonist effects at the A-methyl-D-aspartate (NMDA) receptor; its ability to modulate the expression of NMDA receptor subunlts In specific brain regions may be of relevance for Its anticravlng properties.32 Naltrexone Is hypothesized to reduce ethanol consumption by blocking central opioid receptors, which in turn modulate the positive reinforcing properties of ethanol.33 Nicotine Tobacco Is native to America, where It may have been cultivated by man as early as 5000 to 3000 bc.34 Columbus came Into contact with Indians smoking tobacco when he landed In Cuba, on his very first trip to America.