복용 1주부터 효과 나는 알코올 중독 약물 요법 술을 마시면서도 치료 할 수 있다 > 임상 응용 정보

복용 1주부터 효과 나는 알코올 중독 약물 요법 술을 마시면서도 치료 할 수 있다

페이지 정보

짧은주소

본문

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복용 1주부터 효과 나는 알코올 중독  약물 요법
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술을 마시면서도 치료 할 수 있다
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알코올 중독 증을 치료 할 수 있는 약물 요법이
복용 1주 부터 효과를 발휘하며 
술을 마시면서도 치료 할 수 있다는 사실이 밝혀졌다
 
이는 미국과 독일 8개 의대 연구 팀이 밝혀낸 것이며
미국 의사 회지(JAMA)를 통해 발표된 내용 이다
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항 경련 제 Topiramate 경구 요법</TD></TR>
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보 임상은 알코올 중독 치료를 위해
적어도 한번 이상 입원 치료를 받아 본 자로서
 알코올을 매일 11잔 이상 마시고 있는 중증 중독자를 대상으로 한
이중 맹검 비교 임상 실험이였다 
 
한 잔이라 함은 
100% 절대 알코올 -------15cc
100% proof liquor ------30cc
맥주 ----------------------300cc 에 해당 한다
 
복용 약은 항 경련 제인 Topiramte 을 복용케 했던 바
1주째 부터 효과 효과가 현저히 나타나기 시작했으며
28일간 연속적으로 술을 입에 대지 않은 자들의 숫자가 
2주째부터 계속 증가  했다
(복용 법은 후술)
 
 
<IMG src="/_dimg/2%20그리프%2020130926_092934.png"> 
[그림] 1주 째 부터 술 안 마시는  날들이 계속  증가 
       백색공-----대조군  흑섹공----Topiramate 복용 군
 
 

 
<IMG src="/_dimg/3%20그라프93017.png">
[그림] 28일간 연속적으로 술을 입에 대지 않은 자들의 숫자가 2주째부터 계속 증가
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14 주째 해독 상태는 현저</TD></TR>
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약 복용 중 중독에 빠지는 날짜 수가
82.09%에서 무려 20.0%로 감소한다
 
술을 마시는 날 하루 음주량이 
11잔에서 3.6잔으로 감소한다
 
알코올 중독 시에 증가하고 
알코올 중독 해독 시에는 감소하는 
간 효소  GGT의 수치가 아래 표에서 처럼
3.9에서 -0.09로 현저히 감소한다
(이 수치는 Logarithm 법으로 환산한 비교 수치)
 
 
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치료 전</TD>
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14주</TD></TR>
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 </TD>
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179명 평균</TD>
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113명 평균</TD></TR>
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GGT (LOG 비)</TD>
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3.9</TD>
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-0.09</TD></TR>
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중독에 빠진 날짜 %</TD>
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82.1%</TD>
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20.9%</TD></TR>
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1일 음주량 </TD>
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11 잔</TD>
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3.6잔</TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE>
 
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Topiramate 복용 방법</TD></TR>
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본 임상에서 실시한 
Topiramate의 복ㄹ용 방법은 아래 표와 같다
t
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 </TD>
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오전</TD>
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저녁</TD>
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하루 복용 량</TD></TR>
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0-1주</TD>
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0</TD>
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25mg</TD>
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25mg</TD></TR>
<TR >
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1-2주</TD>
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25mg</TD>
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25mg</TD>
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50mg</TD></TR>
<TR >
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2-3주</TD>
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25mg</TD>
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 63pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #66ff33; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid; " width=84>
25mg</TD>
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50mg</TD></TR>
<TR >
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3-4주</TD>
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25mg</TD>
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 63pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #66ff33; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid; " width=84>
25mg</TD>
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 110.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #66ff33; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid; " width=147>
50mg</TD></TR>
<TR >
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: windowtext 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 63pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid; " width=84>
4-5주</TD>
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100mg</TD>
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100mg</TD>
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200mg</TD></TR>
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5-14주 </TD>
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100mg</TD>
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200mg</TD>
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300mg</TD></TR>
<TR style="mso-yfti-irow: 7; mso-yfti-lastrow: yes">
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중단 시 감량하면서 중단 </TD></TR></TBODY></TABLE>

 
 
 
 
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[그림]Topiramate 
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해독된 자들의 약물 중단법</TD></TR>
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금주가 시작되어 적어도 금주 한 날짜가 
28일 이상 지속된 자로서
중독 상태를 알리는 간 효소치 (GGT) 가 0.004% 이하가 되면 
약물 요법을 중단했다
 
약물 중단 시는 감량 방식으로 중단했다
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약물 부작용</TD></TR>
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약물 복용 중 나타난 부작용은
아래 표에서 처럼 중대한 부작용은 없었다
 
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부작용</TD>
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Topiramate</TD>
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Placebo</TD></TR>
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임상 대상자</TD>
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183 명</TD>
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188명</TD></TR>
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감각이상 (Paresthesia)</TD>
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50.8%</TD>
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10.6%</TD></TR>
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식욕 부진</TD>
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19.7%</TD>
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6.9%</TD></TR>
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집중력 저하</TD>
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14.8%</TD>
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3.2%</TD></TR></TBODY></TABLE>
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Topiramate 의 알코올 중독 해독 원리</TD></TR>
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Topiramate 를 복용하면 
GABA(Gamma –Amino Butyric Acid) 가 지배하는
 신경 전달 경로는 촉진해주고
 Glutamic acid 가 지배하는 신경 전달 경로는 억제 한다
 
이 결과 대뇌 피질의 중독 중추에서 중독 상태를 유지 해 주는  
신경 전달 물질 Dopamine을 정상 농도로 유지 시킨다 
 
알코올 중독자는 Dopamine이 과임인 자로ㅛ서  음주 의욕이 
지나치게 불붙고 있는 자들이다 
 
Topiram,ate 은 이 과잉의 Dopamine 을 감소시켜 
지나친 음주 의욕을 살아지게 힌디

 
 
<IMG src="/_dimg/4%20균형.png">
[그림] Glutamate 와 GABA 는 습관적 행동인 중독을 형성하는 
신경 전달 물질이다  Glutamate 은 뇌의 50%에서 흥분 작용을 일으키고
GABA는 뇌의 3040%에서 억제 작용을 일으킨다
정상인은 이 두 신경 전달 물질의 작용이 균형을 이루고 있다
술이나 마약은 이 두 신경 전잘 물질의 균형을 깨뜨린다
이 두 신경 전달 물질의 균형을 이루는 것은 대뇌피질에서 
Dopamine 이 담당한다
알코콜 중독은 Dopanmine 이 과잉으로 작용하고있는 상태이다
Topiramta 은 이 Dopamine 의 과잉 작용을 감소시켜 중독을 해독한다
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근거</TD>
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2007 Oct.11 JAMA Vol. 298 No. 14, 1641-1651. Topiramate for Treating Alcohol Dependence: A Randomized Controlled Trial,
Bankole A. Johnson, DSc, MD, PhD.et al;Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Dr Anton); Division of Psychiatry, Boston University, Boston,(Dr Ciraulo); Department of Psychiatry, University of Connecticut, (Dr Kranzler); Department of Addictive Behavior and Addiction Medicine, 
University of Heidelberg, Mannheim, Germany (Dr Mann); Department of Psychiatry, Yale University, Connecticut (Dr O’Malley); Department of Psychiatry and Human Behavior, Brown University, (Dr Swift). 
 
May God bless you!
전성수 </TD></TR></TBODY></TABLE>