Zofran- A New Treatment for Cravings

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Ondansetron, the generic of Zofran, has quickly become my favorite drug to use in certain problematic populations.  It has been shown that it reduces cravings.  I am not talking about its use in certain withdrawal states.  I am referring to its' use in patients who are already well into recovery.  Zofran can reduce the intensity of "wanting" the drug, especially in response to stress or triggers.

As I have mentioned elsewhere in this website, hungers,and cravings occur due to a pairing of two things.  First of all, there is the thought about the item, be it a drug or a delicious dessert.  Secondly, there is a release of the neurotransmitter Dopamine into the pleasure center of the brain.  This makes the thought pleasurable which makes the us want the item.  A strong enough desire is a craving; a strong enough craving is an obsession.

If we could minimize the dopamine surge, we will lessen the cravings.  How can we do this.

Accomplia, a successful diet pill available in Europe, does this.  Baclofen, a muscle relaxer does this as well.  The mechanisms by which these drugs accomplish this differ.

Over the last couple of years, another drug has emerged- ondansetron.  It blocks the activity of a certain seratonin receptor- the 5HT3 receptor.  This receptor increases dopamine release; therefore, when it is blocked, dopamine is reduced.

Triggered cravings are less- those cravings from seeing a drug or a plate of cookies.  And it may also reduce stress related cravings.

One problem is that the same type of receptor may stimulate our hypothalamus to make us less hungry,  We could increase our appetite if we block the receptors in this part of the brain.  Therefore, we see that the anti-craving effect is apparent only at very low doses.  As we approach the doses that are available in the commercially availble pills, the anti-craving effect is lost.  Luckily, compounding pharmacies will be able to provide appropriate doses of medication.

The tricky part involves figuring out what type of patient would benefit most.  Early onset male alcoholics (type B alcoholics) have demonstrated the highest benefit.  Yet, I have had other types of alcoholics benefit as well. It has failed to work in studies involving stimulant abusers.  On the other hand, would it be beneficial if combined with other anti-craving drugs such as baclofen.   I am also forced to wonder how it would work in early-onset addictions of different types.

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