Antabuse vs Naltrexone: What’s The Difference?

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Antabuse and Naltrexone are two FDA-approved medications that are prescribed to treat individuals with alcohol use disorders (AUD). 

While they are both used to discourage drinking, Antabuse and Naltrexone work in very different ways.

This article outlines key differences between Antabuse and Naltrexone and provides a comparison to help you determine which medication may be appropriate for you (or someone you know).

Remember to always consult with your doctor before starting a new medication.

Antabuse and Naltrexone must only be used under proper medical supervision, and are best used as part of a comprehensive treatment program for alcohol dependence.

What is Antabuse?

Antabuse is the brand name for disulfiram, which is designed as a deterrent to drinking.

The active ingredient in Antabuse, disulfiram, prevents the body from breaking down alcohol molecules.

During normal alcohol metabolism, an enzyme called alcohol dehydrogenase (ADH) breaks down alcohol into acetaldehyde.

Then, an enzyme called aldehyde dehydrogenase (ALDH) breaks down acetaldehyde into acetic acid, which is further broken down into water and carbon dioxide and eliminated from the body.

Disulfiram interrupts the second step of the metabolism process as it stops ALDH from breaking down acetaldehyde, which results in a high level of acetaldehyde in the body.

This causes an unpleasant physical reaction with symptoms including nausea, vomiting, headaches, intense flushing, and dizziness.

Individuals are encouraged to strictly abstain from alcohol While taking Antabuse because of this ensuing reaction.

What is Naltrexone?

Naltrexone has traditionally been used to treat opioid dependence, but has more recently been approved for the treatment of alcohol use disorder (AUD).

Naltrexone reduces individuals’ desire for alcohol, so it may be effective in helping individuals to either maintain sobriety or achieve moderation.

The rewarding and pleasurable effects of alcohol are mediated partly through the opiate system in the brain.

Naltrexone is an opioid antagonist, meaning it affects the brain’s opiate receptors.

Essentially, Naltrexone blocks the part of the brain that allows you to feel the euphoric and rewarding effects of alcohol.

Therefore, it works to weaken the association between alcohol and pleasure and reduces cravings for alcohol.

Antabuse Vs Naltrexone

Use

A key factor that separates Naltrexone and Antabuse is that while Antabuse is designed to deter individuals from drinking at all, Naltrexone may be used to encourage moderation.

The idea is that Naltrexone helps your brain dissociate alcohol with a pleasurable, rewarding, and euphoric experience, which results in you naturally wanting to reduce consumption.

Naltrexone is typically considered a first-choice medication for AUD as it is safer, does not necessitate alcohol abstinence, and can be taken on an as-needed basis.

On the other hand, Antabuse makes you very sick if you drink any alcohol, so it enforces total abstinence. It also requires close supervision from a physician.

Efficacy and Effectiveness

Antabuse

A 2014 research article analyzed 22 separate studies and trials investigating Antabuse efficacy and concluded that the success rate of Antabuse averages at 72%.

This suggests that the medication is effective at deterring patients from alcohol use and helping them to achieve abstinence.

It is typically accepted that if a patient stays on Antabuse medication for an extended period of time and engages in therapy, they can successfully overcome the physical, mental, and emotional challenges associated with alcohol use disorder and have a higher chance of maintaining long-term sobriety.

Naltrexone

A study investigated whether naltrexone could effectively increase the percentage of days of abstinence from alcohol use in AUD patients when compared to a placebo.

This concluded that the success rate of naltrexone is around 80%.

Side Effects

Antabuse intentionally causes nasty side effects when combined with alcohol.

These include nausea, vomiting, headaches, profuse sweating, facial flushing, dizziness, and chest pain. These side effects are designed to deter individuals from drinking.

However, Antabuse can also produce side effects that are not a result of drinking alcohol but occur as your body becomes accustomed to the medication.

These include drowsiness, headaches, acne, and a metallic taste in the mouth. If these symptoms are particularly bothersome or do not resolve after the first two weeks of use, consult your doctor.

In comparison, Naltrexone is generally well tolerated. However, it may produce similar effects to Antabuse to a more mild degree.

If you consume alcohol While taking Naltrexone and experience trouble breathing, seizures, or chest pain, seek medical attention immediately.

Patient Adherence and Compliance

Treatment with Antabuse requires strict adherence. Patients must completely abstain from alcohol to avoid a severe or dangerous reaction.

It is best suited to patients who are motivated to achieve complete sobriety.

Those with impaired judgment, impulsive tendencies, an urge to relapse, or limited self-control, may not be suitable candidates for antabuse therapy.

On the other hand, Naltrexone does not necessarily require complete abstinence from alcohol.

Patients can still safely drink alcohol while using the medication, but will not experience the rewarding effects.

The medication can be taken as needed (such as during periods of increased cravings). These factors may improve patient adherence to the medication.

Accessibility

Antabuse and Naltrexone are both widely available and can be prescribed by most physicians.

Antabuse patients will be monitored more closely and regularly to ensure they are complying with the medication instructions.

Naltrexone does not require regular monitoring and check-ins with a doctor. This may make it a more convenient option for some individuals.

Cost

The cost of both medications varies depending on factors like insurance coverage, location, and specific pharmacy pricing.

The cost for Antabuse is around $45 for 10 tablets (a 10-day supply), whereas the cost for Naltrexone is around $47 for 30 tablets (a 30-day supply, or longer if taken as needed). Therefore, Naltrexone may be more cost-effective.

Choosing Between Antabuse and Naltrexone

The choice between Antabuse and Naltrexone is dependent on your individual situation, needs, and preferences.

With both medications, efficacy is increased when the medication is used as part of a comprehensive treatment plan that also includes behavioral intervention and psychosocial therapy.

Antabuse is suitable for patients who are highly motivated to completely abstain from alcohol.

Naltrexone may be better suited to patients who are looking to achieve moderation with alcohol consumption.

Talk to your doctor or treatment team about these differing options, to decide which is best suited for you.

Keep in mind that it’s crucial to use either of these medications under proper medical supervision, and to maintain open communication with your doctor.

This will allow your doctor to determine if the medication is working as it should, and if your drinking habits and psychological state are changing in accordance with your treatment goals.

Your doctor may be able to minimize unwanted side effects, and may also change your dosage (or the medication itself) as needed.

Final Thoughts

Medication to help you stop drinking alcohol can be an incredibly useful step towards achieving a complete recovery from alcohol use disorder.

If you are reading this because you are struggling with alcohol, and are actively looking for solutions to change your drinking habits – well done! The first step to recovery is recognizing these issues.

The best way to determine which medication is right for you is to openly discuss your treatment goals with your doctor.

Remember: additional support such as counseling and support groups can help you to increase your chances of achieving your goals as you develop new coping strategies, restructure negative thought patterns, and establish boundaries.

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