Safety of disulfiram in cocaine dependence needs exploring

Despite new research suggesting disulfiram may be effective in treating cocaine dependence, there is not enough evidence to support its clinical use and more work is needed to investigate adverse effects, researchers conclude. The Cochrane Review compared disulfiram with other pharmacological interventions to treat cocaine dependence in 492 adults involved in seven randomised trials. In sensitivity analyses for disulfiram versus placebo, there was a higher dropout rate in placebo groups and a significant favourable trend among disulfiram users. However, the results of three of the studies were not statistically significant. Regression analyses also showed a significantly higher reduction in cocaine use among those who received disulfiram than those assigned to placebo, but again, the results were not statistically significant in all of the studies. In comparison to the opioid antagonist naltrexone three studies found that patients treated with disulfiram had lower dropout rates. One study of 90 patients also found lower dropout rates among disulfiram users versus no pharmacological treatment. However, results were inconsistent in these studies. The researchers noted that the results could not be considered conclusive because of the “low quality of evidence due to study design, small sample size and heterogeneity in terms of outcome operational definition of some of the included studies”. “Moreover, safety issues - particularly those related to the interaction between disulfiram and cocaine - should be deeply explored. This uncertainty requires that clinicians balance the possible benefits against the potential adverse effects of the treatment,” they concluded. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007024...