Drug Safety 三酒精代謝途徑 ( ) 90% 7~10 g/hr ( =1 2100) ( ) ( ) ( ) 表二酒精代謝系統代謝系統酵素與產物說明 1.ADH (alcohol dehydrogenase; ) 2.MEOS (micro

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1 Drug Safety 淺談酒精濫用之風險及戒酒藥物彰化基督醫院雲林分院藥劑課藥師洪千茵徐兆谷李敏齡摘要 alcohol abstinence alcohol abuse cessation medication 壹前言 % 1 貳酒精簡介一淺談酒精 ( ) 二血中的酒精濃度與其影響 BAC (blood alcohol content) (mg/dl) ( ) 表一血中酒精濃度及其導致之臨床症狀 BAC (mg/dl) BAC (%) 臨床症狀 50~ ~ ~ ~ ~ ~ ~ ~0.4 >500 >0.5 藥學雜誌第 110 冊 141

與其影響 BAC (blood alcohol content) (mg/dl) ( ) 表一血中酒精濃度及其導致之臨床症狀 BAC (mg/dl) BAC (%)

2 Drug Safety 三酒精代謝途徑 ( ) 90% 7~10 g/hr ( =1 2100) ( ) ( ) ( ) 表二酒精代謝系統代謝系統酵素與產物說明 1.ADH (alcohol dehydrogenase; ) 2.MEOS (microsomal ethanol oxidizing system; ) 3.ALDH (aldehyde dehydrogenase; ) NAD + NADH+ (NADH ) NADPH NADP + + +ROS ( ) NAD + NADH+ +CO 2 ADH ADH MEOS P450 ( ) ( 二 ) 細胞膜訊息傳遞蛋白圖一乙醇代謝途徑 ( METABOLISM/Pages/pathways_alcohol.aspx) 參酒精導致的不良反應一急性症狀 ( 一 ) 中樞系統 GABA GABA A IPSP (inhibitory postsynaptic potential) glutamate N M D A ( N - m e t h y l - D - aspartate) 2,3 ( 三 ) 心血管系統 (>100 mg/dl) 142 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1

ALDH (aldehyde dehydrogenase; ) NAD + NADH+ (NADH ) NADPH NADP + + +ROS ( ) NAD + NADH+ +CO 2 ADH ADH MEOS P450 ( ) ( 二 ) 細胞膜訊息傳遞蛋白圖一乙醇代謝途徑

3 二慢性症狀 ( 一 ) 肝臟 B C 4 ( 二 ) 腸胃道 ( 三 ) 心血管 ( 四 ) 體液與電解質的失衡 ( 五 ) 免疫系統 T 5 ( 六 ) 神經系統 6 B 1 (Wernicke- Korsakoff syndrome) (delirium tremens) 7 肆酒精中毒的處理與治療一急性中毒的處理二戒除酒癮的治療 disulfiram naltrexone acamprosate topiramate baclofen nalmefene 藥學雜誌第 110 冊 143

4 Drug Safety ( 一 )Disulfiram ALDH Disulfiram 12 ALDH FDA mg ( ) 250 mg disulfiram phenytoin isoniazid disulfiram metronidazole sulfonylurea ( 二 )Naltrexone disulfiram 8 ( 三 )Acamprosate NMDA GABA A 666 disulfiram naltrexone 9 ( 四 )Topiramate G A B A (corticomesolimbic system) (glutaminergic pathways) ( 300 mg/d) 10 ( 五 )Baclofen 2002 Alcohol baclofen 2007 Lancet 11 ( 六 )Nalmefene Nalmefene naltrexone (dose-dependent) nalmefene 12 伍總結 144 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1

)Topiramate G A B A (corticomesolimbic system) (glutaminergic pathways) ( 300 mg/d) 10 ( 五 )Baclofen 2002 Alcohol baclofen

5 參考資料 : 1. Hasin DS, Stinson FS, Ogburn E, et al: Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2007; 64(7): Rezayof A, Sharifi K, Zarrindast MR, et al: Modulation of ethanol state-dependent learning by dorsal hippocampal NMDA receptors in mice. Alcohol 2008; 42(8): Von der Goltz C, Vengeliene V, Bilbao A, et al: Cue-induced alcohol-seeking behaviour is reduced by disrupting the reconsolidation of alcohol-related memories. Psychopharmacology (Berl) 2009; 205(3): Koff RS, Dienstag JL: Extrahepatic manifestations of hepatitis C and the association with alcoholic liver disease. Semin Liver Dis 1995; 15(1): Neuman MG: Cytokines-central factors in alcoholic liver disease. Alcohol Res Health 2003; 27(4): Monforte R, Estruch R, Valls-Sole J, et al: Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol. Arch Neurol 1995; 52(1): Preuss UW, Schuckit MA, Smith TL, et al: Comparison of 3190 alcohol-dependent individuals with and without suicide attempts. Alcohol Clin Exp Res 2002; 26(4): Johnson BA: Naltrexone long-acting formulation in the treatment of alcohol dependence. Ther Clin Risk Manag 2007; 3(5): Mason BJ, Heyser CJ, et al: Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence. CNS Neurol Disord Drug Targets 2010; 9(1): Johnson BA, Rosenthal N, Capece JA, et al: Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Arch Intern Med 2008; 168(11): Addolorato G, Leggio L, Ferrulli A, et al: Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 2007; 370(9603): Soyka M, Rosner S: Nalmefene for treatment of alcohol dependence. Expert Opin Investig Drugs 2010; 19(11): Risks of Alcohol Abuse and Cessation Medication Chien-Yin Hung, Chao-Ku Hsu, Min-Ling Li Department of Pharmacy, Changhua Christian Hospital, Yun-Lin Branch Abstract Excessive alcohol consumption relates to many disorders including liver dysfunction, gastrointestinal disease, elevations of cancer risks, and potential damages to immune system. A wide discussion about alcohol dependence and abuse has become a long-term debatable social issue in our country. Through this article, disadvantages and diseases relating to alcohol abuse are being discussed, demonstrating the importance of alcohol abstinence. The main goal of this article is making advances to promote public health in Taiwan by improving the clinical application of alcohol-cessation medication based on knowing the metabolic mechanism. 藥學雜誌第 110 冊 145

on Alcohol and Related Conditions. Arch Gen Psychiatry 2007; 64(7): 830-42. 2. Rezayof A, Sharifi K, Zarrindast MR, et al: Modulation of ethanol state-dependent learning by dorsal hippocampal NMDA receptors in mice.

Microsoft Word - 酒與健康李品彗.doc

Microsoft Word - 酒與健康李品彗.doc 酒精及戒酒李品慧醫師 " 來, 乾一杯!" 這句話似乎在我們的生活中此起彼落的出現, 但是有多少人能夠瞭解酒具有什麼樣的作用, 對我們的身體又有什麼樣的影響? 還是你只是認為他是抒解壓力, 消除憂愁的工具? 酒精是一種中樞神經抑

Drug Safety 三 酒 精 代 謝 途 徑 ( ) 90% 7~10 g/hr ( =1 2100) ( ) ( ) ( ) 表 二 酒 精 代 謝 系 統 代 謝 系 統 酵 素 與 產 物 說 明 1.ADH (alcohol dehydrogenase; ) 2.MEOS (micro

Drug Safety 三酒精代謝途徑 ( ) 90% 7~10 g/hr ( =1 2100) ( ) ( ) ( ) 表二酒精代謝系統代謝系統酵素與產物說明 1.ADH (alcohol dehydrogenase; ) 2.MEOS (micro