Does Disulfiram (Antabuse) increase the risk of suicide?

From the Guidelines

Disulfiram does not appear to significantly increase suicide risk for most patients. Disulfiram (commonly known by the brand name Antabuse) is a medication used to treat alcohol use disorder by causing unpleasant reactions when alcohol is consumed. While all medications for substance use disorders require careful monitoring, current evidence does not suggest that disulfiram specifically increases suicidal thoughts or behaviors in the general population of patients 1. However, caution should be exercised when prescribing disulfiram to patients with pre-existing depression, severe psychiatric disorders, or a history of suicidal ideation, as these individuals may require closer monitoring. The typical dosage of disulfiram is 250-500 mg daily, taken in the morning or at bedtime. Patients should be aware that disulfiram remains active in the body for up to 14 days after the last dose, so alcohol must be avoided during this period. The medication works by inhibiting the enzyme aldehyde dehydrogenase, which is involved in alcohol metabolism, causing acetaldehyde to build up if alcohol is consumed, resulting in nausea, flushing, and other unpleasant symptoms. This pharmacological action is not directly linked to mechanisms that would increase suicide risk.

Some studies have investigated the effectiveness of disulfiram in treating alcohol use disorder, but they do not provide evidence of an increased suicide risk 1. In fact, disulfiram is considered a useful medication for reducing relapse in alcohol-dependent patients, and its use is recommended as part of treatment, taking into consideration patient preferences, motivation, and availability 1.

It is essential to note that patients with alcohol use disorder may have co-occurring mental health conditions, such as depression, which can increase the risk of suicidal thoughts or behaviors. Therefore, careful assessment and monitoring of these patients are crucial when prescribing disulfiram or any other medication for substance use disorders.

In terms of monitoring and management, patients taking disulfiram should be regularly assessed for signs of depression, suicidal ideation, or other mental health concerns. If any of these concerns arise, the patient's treatment plan should be adjusted accordingly, and they may require closer monitoring or referral to a mental health specialist.

Overall, the current evidence suggests that disulfiram is a safe and effective medication for treating alcohol use disorder, and it does not appear to significantly increase suicide risk for most patients. However, as with any medication, careful monitoring and management are essential to minimize potential risks and ensure the best possible outcomes for patients.

From the Research

Disulfiram and Suicide Risk

• There is no direct evidence in the provided studies that disulfiram increases suicide risk 2, 3, 4, 5, 6.
• The studies focus on the efficacy and safety of disulfiram in treating alcohol dependence with comorbid psychiatric disorders, such as depression and post-traumatic stress disorder (PTSD) 3, 4.
• One study found that disulfiram and naltrexone are safe pharmacotherapeutic agents for dually diagnosed individuals with depression for the treatment of alcohol use disorders 3.
• Another study suggested that disulfiram and naltrexone are effective and safe for individuals with PTSD and comorbid alcohol dependence 4.
• However, none of the studies explicitly address the relationship between disulfiram and suicide risk.

Disulfiram Side Effects

• The studies mention that disulfiram can cause psychiatric side effects and interact with various psychiatric medications 2.
• One study found that individuals with PTSD were more likely to report some side effects when treated with the combination of disulfiram and naltrexone 4.
• Another study found that participants with problem-gambling features reported significantly less improvement over time in general psychiatric functioning, specifically within certain domains 6.

Disulfiram Efficacy

• The studies suggest that disulfiram is a useful treatment option for patients with alcohol dependence and other psychiatric disorders 2, 3, 4, 5.
• One study found that disulfiram and naltrexone are effective in reducing alcohol use and improving psychiatric symptoms in individuals with comorbid psychiatric disorders 5.
• However, the studies do not provide direct evidence on the relationship between disulfiram and suicide risk.