Chronic disulfiram treatment effects on intranasal cocaine administration: Initial results

• Published in: Biological psychiatry (1969) Vol. 43; no. 7; pp. 540 - 543
• Main Authors: McCance-Katz, Elinore F., Kosten, Thomas R., Jatlow, Peter
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-1998; Elsevier Science
• Subjects: Administration, Intranasal; Adult; alcohol; Alcohol Deterrents - adverse effects; Alcohol Deterrents - blood; Alcohol Deterrents - therapeutic use; Antabuse; Biological and medical sciences; Blood Pressure - drug effects; Cocaine; Cocaine - administration & dosage; Cocaine - blood; disulfiram; Disulfiram - adverse effects; Disulfiram - blood; Disulfiram - therapeutic use; Double-Blind Method; Drug addictions; drug interaction; Female; Heart Rate - drug effects; Humans; Male; Medical sciences; pharmacotherapy; Substance-Related Disorders - blood; Substance-Related Disorders - drug therapy; Substance-Related Disorders - psychology; Toxicology; alcohol; Cocaine; disulfiram; pharmacotherapy; drug interaction; Antabuse; Human; Drug addiction; Alcoholism; Detoxification; Intranasal administration; Toxic association; Alcoholic beverage; Chemotherapy; Treatment; Dependence; Disulfiram; Drug poison interaction; Pharmacokinetics
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/S0006-3223(97)00506-4

Simultaneous abuse of cocaine and alcohol is common. Alcohol decreases negative stimulant effects and potentiates “high.” Disulfiram (Antabuse) is being studied in outpatient trials as a cocaine pharmacotherapy with the rationale that inability to modulate cocaine effects with alcohol may decrease cocaine use.
We examined the interaction of disulfiram and cocaine in a randomized, double-blind, placebo-controlled study where subjects were chronically treated with disulfiram and then participated in intranasal cocaine administration studies.
Disulfiram 250 mg/day treatment significantly increased plasma cocaine concentrations (p = .013), heart rate (cocaine 1 mg/kg, p = .046), and systolic (cocaine 2 mg/kg p = .003) and diastolic (cocaine 2 mg/kg, p = .022) blood pressure. “High” and “nervous” ratings were nonsignificantly increased.
The combination of “high” with increased anxiety in the context of inability to lessen negative effects with alcohol may be an effective treatment in selected patients. The significant pharmacokinetic interaction must be considered in the decision regarding use of disulfiram.