HUNTINGTON BEACH, Calif. -- Lorazepam (Ativan) appeared to be a safe and effective treatment for anxiety in patients with alcohol use disorder who were already taking disulfiram (Antabuse), researchers reported here, but adherence to disulfiram was a problem.
In the pilot study, which had no control group, 41 patients with alcohol dependence and co-occurring anxiety disorder were given lorazepam, a benzodiazepine that was tapered from weeks 9 to 15, and disulfiram, which was stopped at the end of week 15.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
At 16 weeks, the drugs had a favorable effect on craving (g=1.28), depression (g=1.22), anxiety (g=1.84), percent days abstinent (g=1.16), and percent days abstinent imputed (g=0.76), according to , of the University of New Mexico in Albuquerque, and colleagues in a poster presentation at the American Academy of Addiction Psychiatry meeting.
"Treatment adherence to disulfiram seems to be pretty low, and one of the reasons for relapse often is anxiety," said Prasad in an interview with 鶹ý. "We thought if we could help with anxiety, it might help with adherence to disulfiram, and whether that would affect outcomes."
Disulfiram has been used for decades despite often not outperforming placebo, she added. A common reason that patients give for relapsing while on disulfiram is anxiety.
In the trial, there were no serious adverse events, though 15 of the patients received new or additional treatment for their mood or anxiety disorder, Prasad said. There were only 26 of the original group of 41 patients available for follow-up at 16 weeks, so adherence was still poor.
"This was a very monitored study," she explained. "And at the end of the study, we still found that adherence to disulfiram was pretty low -- equal to or lower than some of the other studies out there."
The duration of adherence to disulfiram predicted abstinence at 16 weeks (P<0.001), though use of lorazepam was not predictive of percent days abstinent. There was no evidence that lorazepam was abused, and dose escalation wasn't required during the study.
Also, there were no predictors of drinking outcome at baseline, although a lower craving score did predict abstinence at the end of treatment, only if it was assumed that the patients lost to follow-up had resumed drinking, the authors stated.
"We need more studies," Prasad said. "We need a larger, double-blinded study to see if this is something that can be used clinically in the future."
Disclosures
The study was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism.
Primary Source
American Academy of Addiction Psychiatry
Bogenschutz M, et al "Co-administration of disulfiram and lorazepam in the treatment of alcohol dependence and co-occuring anxiety disorder" AAAP 2015; Poster B-17.