Home > Disulfiram for the treatment of cocaine dependence.

Pani, Pier Paolo and Trogu, Emanuela and Vacca, Rosangela and Amato, Laura and Vecchi, Simona and Davoli, Marina (2010) Disulfiram for the treatment of cocaine dependence. Cochrane Database of Systematic Reviews, (1), Art. No.: CD007024. DOI: 10.1002/14651858.CD007024.pub2.

External website: https://www.cochranelibrary.com/cdsr/doi/10.1002/1...

Objective: To evaluate the efficacy and the acceptability of disulfiram for cocaine dependence.

Cocaine is used as powder for intranasal or intravenous use, or smoked as crack. Dependence on cocaine can cause major public health problems because of its psychological, social and medical impacts, including the spread of infectious diseases such as AIDS, hepatitis and tuberculosis. No proven pharmacological treatment of cocaine dependency exists as yet. Disulfiram is marketed for the treatment of alcoholism and interferes with the metabolism of alcohol. It may also be useful in treating cocaine dependence. Evidence from randomised controlled trials to support the clinical use of disulfiram in people with cocaine dependence is limited. The review authors identified seven controlled studies that randomised a total of 492 participants to receive disulfiram, a placebo, no pharmacological treatment or naltrexone in addition to psychosocial treatment. Their mean age was 38 years and the studies took place in an outpatient setting over a mean time of 12 weeks. All trials but one were conducted in the USA. Five studies enrolled patients with cocaine dependence and alcohol abuse or dependence. Two enrolled people with concurrent opioid addiction who were undergoing treatment with buprenorphine or methadone.

Disulfiram showed a trend toward fewer dropouts from psychosocial treatment when compared to placebo (three trials) or naltrexone (three trials) but this was not statistically significant. Assessing cocaine use, single studies were in favour of disulfiram on number of weeks of abstinence in one out of four comparisons when compared with placebo and on maximum weeks of consecutive abstinence and number of people achieving three or more weeks of consecutive abstinence in one study comparing disulfiram to no pharmacological treatment.

The included studies did not specifically investigate the adverse effects of disulfiram itself or its potential to increase alcohol and cocaine adverse effects.

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