Can a Patient Take Lexapro and Antabuse Together?
Yes, a patient with depression and alcohol use disorder can safely take Lexapro (escitalopram) and Antabuse (disulfiram) together, as research demonstrates these medications are safe pharmacotherapeutic agents for dually diagnosed individuals with depression and alcohol use disorders. 1
Evidence for Combined Use
The combination of an antidepressant (like escitalopram) with disulfiram has been specifically studied in patients with co-occurring depression and alcohol dependence:
A randomized controlled trial of 254 patients with major psychiatric disorders and alcohol dependence found no relationship between depression diagnosis and medication treatment (including disulfiram and naltrexone) on alcohol use outcomes, psychiatric symptoms, or side effect reporting. 1
The study concluded that disulfiram is a safe pharmacotherapeutic agent for dually diagnosed individuals with depression for treating alcohol use disorders. 1
Patients with depression taking disulfiram actually reported lower alcohol craving over time compared to other medication groups. 1
Treatment Approach for Co-Occurring Disorders
Both conditions should be treated simultaneously for optimal outcomes:
Evidence suggests the best outcome for individuals with co-occurring depression and substance use disorders is treating both conditions simultaneously. 2
An integrated approach where ongoing evaluation and treatment are provided under one roof according to evolving patient needs has proven efficacious. 3
Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy. 3
Medication Selection Considerations
For the alcohol use disorder component:
Acamprosate, disulfiram, or naltrexone should be offered as part of treatment to reduce relapse in alcohol dependent patients, with the decision made considering patient preferences, motivation, and availability. 4
Disulfiram works by inhibiting aldehyde dehydrogenase (ALDH), causing toxic acetaldehyde accumulation when alcohol is consumed, producing unpleasant symptoms including flushing, dizziness, nausea, vomiting, arrhythmia, dyspnea, and headache. 4, 5
For the depression component:
Treatment for depression co-occurring with alcohol use disorder is associated with large early improvement in depression symptoms, even within the first 3-6 weeks. 6
The effect of antidepressant therapy on depression in patients with alcohol use disorders is modest but beneficial, with stronger evidence when depression is independent of drinking. 6
Critical Contraindications to Monitor
Disulfiram has important contraindications that must be assessed:
Disulfiram is contraindicated in patients with alcoholic liver disease or severe hepatic dysfunction, as it carries hepatotoxicity risk. 4, 7, 5
If the patient has liver cirrhosis or significant hepatic impairment, baclofen is the preferred medication for maintaining alcohol abstinence instead of disulfiram. 4, 5
Naltrexone should also be avoided in patients with active alcoholic liver disease due to hepatotoxicity risk. 7
Essential Monitoring and Support
Comprehensive management requires:
Psychosocial support should be routinely offered to alcohol dependent patients, with structured psychological interventions such as motivational techniques and cognitive behavioral therapy when providers have capacity. 4
Family members should be involved in treatment where appropriate, and patients should be encouraged to engage with mutual help groups such as Alcoholics Anonymous. 4
Thiamine supplementation should be administered to all patients undergoing alcohol withdrawal management, with parenteral thiamine for those at high risk or with suspected Wernicke's encephalopathy. 4, 7
Drug Interaction Profile
The combination of escitalopram and disulfiram does not have clinically significant pharmacokinetic interactions:
In the network meta-analysis of alcohol dependence treatments, citalopram/escitalopram (the same drug class as Lexapro) was studied alongside various other interventions including disulfiram without safety concerns noted for combinations. 4
No evidence of increased adverse events or contraindications exists for combining SSRIs with disulfiram in patients with co-occurring disorders. 1