Eficacia y mecanismo de acción de la monoterapia con Topiramato en el manejo del trastorno por consumo de alcohol
Resumen
Objetivo: Evaluar la eficacia y mecanismo de acción del Topiramato cómo tratamiento farmacológico en el síndrome de abstinencia en adultos. Materiales y métodos: Se utilizaron criterios de búsqueda de publicaciones para pacientes adultos con síndrome de abstinencia por consumo de alcohol en PubMed, Embase y Scopus. Se excluyeron publicaciones que incluyeran pacientes con condiciones médicas cómo trastorno por consumo otras sustancias psicoactivas o de enfermedades mentales. Se llevó a cabo un proceso de selección y análisis siguiendo la metodología Prisma. Se seleccionaron revisiones sistemáticas y ensayos clínicos aleatorizados. La revisión se realizó en inglés y español en noviembre de 2023. Resultados: Se revisaron artículos que incluyeron once revisiones sistemáticas, cuatro metaanálisis y dieciséis ensayos clínicos aleatorizados, centrados en pacientes con trastorno de abuso de alcohol (AUD). Se comparó el uso de Topiramato con placebo u otros medicamentos. Los resultados evidenciaron que el Topiramato tiene ventajas sobre el placebo, incluyendo un mayor porcentaje de abstinencia, menor consumo de alcohol y mejoras en las pruebas hepáticas, en particular, la Gamma Glutamil Transferasa (GGT). Además, el Topiramato podría contrarrestar los efectos gratificantes del alcohol, posiblemente mediante la inhibición de la liberación de dopamina o glutamato. Conclusiones: El Topiranato es un anticonvulsivante que influye en las vías dopaminérgicas y glutamatérgicas, reduciendo el consumo de alcohol y aumentando la abstinencia en comparación con otros medicamentos. Las indicaciones clínicas y paraclínicas para su uso aún carecen de consenso.
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Derechos de autor 2024 Paola Andrea Cuestas-Grijalba, Isaac Arbelaez-Quintero
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