Antabuse and Vivitrol are two well-researched, FDA-approved medications that are prescribed in the treatment of alcohol use disorder (AUD).
These two medications work in very different ways, and therefore have different uses and are suitable for different patients and candidates.
This article comprehensively compares Antabuse and Vivitrol to provide you with a better understanding of the mechanism of action, use, efficacy, potential side effects, administration, and dosage of each medication.
If you are seeking medication to assist in your alcohol dependence recovery journey, keep reading.
What is Antabuse?
Antabuse is the brand name for disulfiram, a medication that has been approved by the Food and Drug Administration (FDA) for treating AUD.
It is designed to act as a deterrent to drinking. When you are taking Antabuse and consume alcohol in any amount, you will experience a highly unpleasant physical reaction which should deter you from drinking.
Antabuse medication treatment requires complete abstinence from alcohol.
What is Vivitrol?
Vivitrol is the brand name for the injectable form of naltrexone – a medication that has recently been FDA-approved for treating AUD.
Naltrexone’s mechanism of action reduces the pleasurable and rewarding effects of alcohol from being experienced.
It can be useful in helping to reduce cravings for alcohol while weakening the association between alcohol and pleasure, which may encourage moderation or sobriety.
Antabuse vs Vivitrol: A Comparison
How It Works
Antabuse
The key ingredient in Antabuse, disulfiram, disrupts alcohol metabolism.
Alcohol metabolism occurs through a series of bodily functions and processes. When we consume alcohol, an enzyme called alcohol dehydrogenase (ADH) converts alcohol molecules into acetaldehyde.
Then, an enzyme called aldehyde dehydrogenase (ALDH) converts acetaldehyde into acetate. Acetate is then broken down into water and carbon dioxide, and eliminated from the body through urine and breathing.
Disulfiram’s mechanism of action stops ALDH from working, so acetaldehyde is not broken down into acetate and instead accumulates in the body.
Acetaldehyde is a toxic substance, so an accumulation of it causes a highly unpleasant physical reaction with symptoms including headaches, nausea, profuse vomiting, profuse sweating, and flushing. In medical terms, this is known as the disulfiram-alcohol reaction.
These resulting symptoms are why Antabuse can be so effective; it discourages people from drinking so that they can avoid this nasty experience.
Vivitrol (Naltrexone)
Did you know alcohol is partly mediated through the same part of the brain that mediates heroin?
This is why naltrexone, which has traditionally been used to treat opioid dependence, can be effective in treating AUD patients.
Naltrexone (the key ingredient in Vivitrol) is a μ opioid receptor antagonist.
In other words, it blocks the part of our brain that processes the rewarding effects of alcohol. This weakens the mental association between alcohol and pleasure, and subsequently, reduces desire and cravings for alcohol.
Naltrexone can be useful in making alcohol seem less appealing.
When you have Naltrexone present in your body, you may be more inclined to drink in moderation because your brain is now unable to associate alcohol consumption with pleasure or reward.
Uses
As mentioned, Antabuse is designed to deter individuals from drinking any amount of alcohol because of the unpleasant physical reaction that ensues. It is used to encourage/enforce complete abstinence.
On the other hand, Vivitrol can be used to encourage moderation.
Vivitrol patients may choose to still drink some alcohol (e.g. in social settings), but will naturally reduce their consumption due to the medication weakening the mental association between alcohol and reward.
For instance, Vivitrol may result in individuals having no desire to continue drinking after their first beverage, as their brains cannot “feel” the pleasurable effects.
Efficacy
Antabuse
Antabuse has proven to be an effective deterrent to drinking alcohol, both physically and psychologically.
A 2014 publicationanalyzed 22 different studies investigating disulfiram efficacy in the treatment of alcohol dependence and concluded that the success rate of disulfiram is 72% – meaning it increased the number of abstinent days in 72% of cases.
Therefore, disulfiram effectively supports abstinence from alcohol.
Vivitrol
In a study of 624 AUD patients, those who received Vivitrol (alongside counseling) had 25% fewer heavy drinking days (defined as 5 or more drinks per day) each month than those who received a placebo.
This indicates the significant efficacy of the medication.
Side Effects
Antabuse
Antabuse is designed to cause unpleasant side effects as a result of alcohol consumption. These include headache, nausea, vomiting, sweating, impaired vision, weakness, and confusion.
However, Antabuse may also cause side effects that are not a result of alcohol consumption.
These typically occur as your body becomes accustomed to the drug, and include acne, drowsiness, headache, and a metallic taste in the mouth.
Vivitrol
Vivitrol may cause minor side effects, including nausea, headache, dizziness, drowsiness, anxiety, and loss of appetite. These tend to be mild and resolve as your body becomes accustomed to the presence of the drug.
Vivitrol has the potential to damage the liver, so it should not be used by individuals with a history of liver disease.
Vivitrol may also cause a depressed mood, which is considered a serious side effect, as it can lead to suicidal thoughts or behavior. This side effect requires immediate medical attention.
Administration and Dosage
Antabuse
Antabuse is administered in an oral tablet formulation.
During the initial treatment phase, patients will typically be given the maximum recommended dosage of 500 mg per day, which will be reduced to around 250 mg per day for maintenance treatment.
The right dose of Antabuse will vary for each individual and is dependent on a variety of factors such as age, weight, medical history, and tolerance.
Vivitrol
Vivitrol is administered via an extended-release injection. It is given once a month by a trained medical professional.
Typically, 380 mg of naltrexone is delivered intramuscularly and gradually released into the bloodstream over the month, at a controlled and near-constant rate.
Cost and Insurance Coverage
Antabuse
Antabuse costs around $46 for a monthly supply of 30 tablets and is usually covered by insurance.
Vivitrol
Without insurance, the cost of Vivitrol is around $1178 for a single injection. This may seem steep, but 99% of people with insurance are covered for Vivitrol, which can significantly decrease this cost.
Summary
Antabuse Pros
- More affordable than Vivitrol
- Only needs to be taken once daily
- Effective at managing AUD.
Antabuse Cons
- Requires strict medication adherence. Patients must completely abstain from alcohol consumption during treatment. (best suited for patients who are highly determined to maintain sobriety)
- Even small amounts of alcohol (which can be found in food and hygiene products) can trigger an unpleasant reaction
- Does not reduce cravings for alcohol.
Vivitrol Pros
- Administered in injection form once a month. Patients do not need to self-administer a tablet daily, which may be more convenient
- Can be used to encourage abstinence OR moderation
- Reduces cravings for alcohol.
Vivitrol Cons
- Can cause minor side effects like headaches and nausea
- Not suitable for those with liver problems.
Final Thoughts
Antabuse and Vivitrol and two medications prescribed for treating alcohol dependence, that work in very different ways.
Antabuse is an oral tablet that is taken once daily, which works to deter individuals from drinking.
Vivitrol is an extended-release monthly injection that reduces cravings and desire for alcohol by affecting the part of the brain that associates alcohol with pleasure.
Keep in mind that both of these medications are most effective when used alongside behavioral and psychosocial support resources, such as counseling.
If you believe you or someone you know may benefit from either medication, reach out to a doctor or specialized alcohol treatment center.
Working with a professional is crucial as they will be able to assess your situation and collaborate with you to create a tailored treatment plan.
