Disulfiram or Naltrexone for Alcohol Dependence?
Both disulfiram and naltrexone have proven efficacy for treating alcohol dependence. However, few studies have compared these treatments. In an open-label trial, researchers in India randomized 100 men with alcohol dependence to receive either naltrexone (50 mg per day) or disulfiram (250 mg per day). All patients had a family member accompany them to follow-up appointments, received weekly supportive psychotherapy and, when symptomatic, were prescribed sertraline for depression and zolpidem for insomnia.
Follow-up at 1 year was 97%. Compared with the naltrexone group, patients in the disulfiram group had significantly more days abstinent (means 306 days versus 243 days), longer time to relapse (defined as drinking approximately >=3–4 standard drinks in 24 hours; means 119 days versus 63 days), and lower serum gamma-glutamyltransferase levels (means 85 U/L versus 107 U/L). Patients in the naltrexone group had less craving.
The primary limitations of this study were the lack of blinding and the lack of a placebo control group. In addition, generalizability of the results may be limited to patients with substantial social support. Nonetheless, this study suggests that disulfiram, at least in some cases, may have advantages over naltrexone for the treatment of alcohol dependence.Richard Saitz, MD, MPH
De Sousa A, De Sousa A. A one-year pragmatic trial of naltrexone versus disulfiram in the treatment of alcohol dependence. Alcohol Alcohol. 2004;39(6):528–531.