Chronic disulfiram treatment effects on intranasal cocaine administration: initial results

Biol Psychiatry. 1998 Apr 1;43(7):540-3. doi: 10.1016/S0006-3223(97)00506-4.


Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Intranasal
  • Adult
  • Alcohol Deterrents / adverse effects
  • Alcohol Deterrents / blood
  • Alcohol Deterrents / therapeutic use*
  • Blood Pressure / drug effects
  • Cocaine* / administration & dosage
  • Cocaine* / blood
  • Disulfiram / adverse effects
  • Disulfiram / blood
  • Disulfiram / therapeutic use*
  • Double-Blind Method
  • Female
  • Heart Rate / drug effects
  • Humans
  • Male
  • Substance-Related Disorders / blood
  • Substance-Related Disorders / drug therapy*
  • Substance-Related Disorders / psychology


  • Alcohol Deterrents
  • Cocaine
  • Disulfiram