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.

Comments:

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

Reference:

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.