Preparat: Antabus, Antabus®, Antabuse, Disulfiram, Disulfiram WZF
ATC kod: N07BB01
Tolkning av resultaten från kliniska studier försvåras av att få kvinnor varit inkluderade vilket delvis skulle kunna förklara varför flera studier visat signifikant effekt av disulfiram hos män men inte hos kvinnor.
Kunskapsunderlaget avseende skillnader mellan kvinnor och män är begränsat och motiverar inte olika dosering eller behandling.
The risk of alcohol use according to the Global Burden of Disease Study 2010, was ranked as number three in men and number twelve in women. Disability-adjusted life years were three times higher in men than in women and alcohol related deaths were twice as common in men as in women .
In Sweden, hospital care due to alcohol related diagnoses were twice as common in men compared to women in 2012 and alcohol related deaths were more common in men than in women .
A laboratory study of disulfiram added to blood from alcoholic patients (n=26) and healthy controls (n=18) reported that the metabolism of the ethanol metabolite acetaldehyde was inhibited similarly in men and women . No sex differentiation in dosing has been recommended by the manufacturer .
Alcohol dependenceIn an observational study, patients with alcohol dependence (176 men, 33 women) were prescribed disulfiram (82%), acamprosate (14%) or disulfiram + acamprosate (10%) in addition to supportive counseling during 6 months. It showed that absence of heavy relapse in drinking was higher in men than in women (56% vs. 36%) . Similarly, a review of disulfiram treatment in alcoholism including data from two large trials in alcoholics (500 men, 60 women and also 1020 patients with unknown sex distribution) showed a better outcome in men than in women [6, 7].
Opioid dependenceA Cochrane report states that there is little evidence supporting the clinical use of disulfiram in the treatment of cocaine dependence . Disulfiram is not approved for treatment of opioid dependence in Sweden or the US [4, 9].
Two pooled analyses of six randomized placebo-controlled trials of disulfiram and behavioral therapies during 8-12 weeks in cocaine dependent patients (324 men, 179 women, in all) showed a poorer outcome in women than in men [10, 11].
No studies with a clinically relevant sex analysis regarding the adverse effects of disulfiram have been found.
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
A retrospective cross-sectional study of patients with alcohol dependence (833 men, 218 women) treated with supportive counseling and disulfiram or naltrexone showed that the retention of treatment was similar in men and women .
A US study based on data from Veterans Health Administration (VHA) of treatment of alcohol misuse (270 774 men, 9 319 women) showed that women were more likely than men to receive a prescription of acamprosate (1% vs. 0.6%), naltrexone (2.9% vs. 1.6%), disulfiram (1.8% vs 1.1%), or any medication (5.2% vs. 3%). The odds ratio for receiving any of these medications was 1.58 in women compared to men .
Randomized studies of compliance to disulfiram treatment (291 men, 143 women) of cocaine dependence have shown no sex differences .
Fler män än kvinnor hämtade ut tabletter innehållande disulfiram (ATC-kod N07BB01) på recept i Sverige år 2015, totalt 8 665 män och 3 531 kvinnor. Det motsvarar 1,8 respektive 0,7 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 50-59 år hos båda könen. I genomsnitt var tabletter innehållande disulfiram 3,7 gånger vanligare hos män .
Faktagranskat av: Mia von Euler
Godkänt av: Karin Schenck-Gustafsson