VIENNA – Disulfiram has a far more truncated role in the treatment of cocaine dependence than once envisioned, Frank J. Vocci, Ph.D., said at the annual congress of the European College of Neuropsychopharmacology.
When the first signals appeared that disulfiram (Antabuse) was effective in treating cocaine dependence, addiction specialists were excited at the prospect of finally having a drug for dual cocaine/alcohol dependence–a common problem that is extremely difficult to treat.
It seemed logical, given that disulfiram has been approved by the Food and Drug Administration for the treatment of alcohol dependence for more than 55 years.
But it was not to be, said Dr. Vocci, director of the division of pharmacotherapies and medical consequences of drug abuse at the National Institute of Mental Health, Bethesda, Md.
Indeed, analysis of the aggregate data from all clinical trials of disulfiram to date–and disulfiram is the best-studied medication for cocaine dependence–indicates that while the drug does result in a mild to moderate reduction in cocaine use, the benefit is restricted to those people who are not alcohol users during the study period.
Moreover, a striking gender disparity was found: Disulfiram simply is not effective in women, who account for roughly half of the more than 3 million long-term cocaine users in the United States.
The current thinking is that disulfiram is effective in cocaine users who have a variant of the dopamine beta-hydroxylase gene.