From the Guidelines
Disulfiram (Antabuse®) is not recommended as a first-line treatment for alcoholism due to limited evidence supporting its effectiveness in maintaining abstinence and potential risks of hepatotoxicity, as noted in studies such as 1 and 1.
Key Considerations
- The most recent and highest quality studies, including a 2020 systematic review and network meta-analysis published in the BMJ 1, found limited evidence to support the use of disulfiram in maintaining abstinence from alcohol.
- Another study published in 2020 in the journal Hepatology 1 does not recommend disulfiram for use in patients with alcohol-associated liver disease due to its potential for hepatotoxicity.
- The 2022 clinical guidelines from the French Association for the Study of the Liver and the French Alcohol Society 1 mention disulfiram as one of the pharmacological aids for maintaining long-term low or zero consumption targets, but also highlight the need for careful assessment of the benefit-risk ratio.
Treatment Alternatives
- Acamprosate is recommended as a first-line treatment for maintaining abstinence in patients with alcohol dependence, as it has been shown to be effective in reducing withdrawal symptoms and improving outcomes, as noted in studies such as 1 and 1.
- Naltrexone is another option for preventing relapse in patients with alcohol dependence, although its use may be limited by hepatotoxicity concerns, as mentioned in 1.
Important Safety Information
- Patients with alcohol-associated liver disease should be cautious when using disulfiram due to its potential for hepatotoxicity, as noted in 1.
- Medical supervision is essential when starting and discontinuing disulfiram, and patients should be closely monitored for signs of adverse reactions, as mentioned in 1 and 1.
From the FDA Drug Label
Disulfiram is an aid in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage. Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.
Disulfiram (Antabuse®) treats alcoholism by aiding in the management of chronic alcoholism, but it is not a cure. It works by producing a sensitivity to alcohol, resulting in an unpleasant reaction when alcohol is consumed. The medication should be used in conjunction with motivation and supportive therapy to be effective 2.
From the Research
Disulfiram (Antabuse®) in the Treatment of Alcoholism
- Disulfiram is one of the medications approved for the treatment of alcohol use disorder, along with naltrexone and acamprosate 3.
- The effectiveness of disulfiram in treating alcoholism has been demonstrated in several studies, with supervised intake of disulfiram proving to be an effective adjunct to biopsychosocial alcoholism therapy 4.
- A meta-analysis of pharmacological therapy for alcoholism found that disulfiram appeared to be effective only when the intake was supervised 5.
- A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone, and acamprosate in the treatment of alcohol dependence found that supervised disulfiram was more effective in reducing heavy drinking days and average weekly alcohol consumption, and increasing time to the first drink, as well as the number of abstinent days 6.
Comparison with Other Medications
- Disulfiram has been compared to other pharmacological agents, such as naltrexone and acamprosate, in the treatment of alcoholism, with some studies suggesting that disulfiram is equal or superior to these medications 4, 6.
- A review of the safety and tolerability of pharmacological treatment of alcohol dependence found that disulfiram, naltrexone, and acamprosate have different safety profiles that need to be balanced with the treatment objective and individual patient preferences and comorbid conditions 7.
Supervised Disulfiram
- Supervised disulfiram has been shown to be an effective therapeutic tool in the treatment of alcoholism, with therapy programs that make use of the psychological effects of supervised disulfiram having better results than programs that neglect psychological effects 4.
- The use of supervised low-dose disulfiram (not more than 100mg/d) has been suggested to show the highest success when carefully integrated into psychotherapeutic alcoholism therapy 4.