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Antabuse vs Vivitrol
Introduction
For patients grappling with alcohol use disorder (AUD), certain medications that affect the brain's reward system can assist in discouraging substance misuse and manage withdrawal symptoms. Antabuse and Vivitrol are two such drugs often prescribed to aid in managing AUD. They each impact different aspects of cravings, but both have been shown to help patients maintain sobriety. Antabuse, or disulfiram, works by causing a severe adverse reaction when alcohol is consumed - including nausea, flushing, and heart palpitations - thus discouraging consumption due to these unpleasant side effects. Vivitrol on the other hand, also known as naltrexone, reduces the euphoric feeling associated with drinking alcohol by blocking opioid receptors in the brain that release dopamine when alcohol is consumed.
Antabuse vs Vivitrol Side By Side
| Attribute | Antabuse | Vivitrol |
|---|---|---|
| Brand Name | Antabuse | Vivitrol |
| Contraindications | Should not be used if you've consumed any form of alcohol within the last 12 hours to two weeks. Not to be used if taking opioid medications or have been within the past 7-10 days. | Should only be used in patients who have been detoxed from alcohol or opioids and have been abstinent for at least 7-10 days. Must avoid using any type of opioids while on Vivitrol. |
| Cost | Averages around $90 for a 30-day supply (30 tablets) of 250 mg. Generic version costs between $.50 and $1.50 per tablet. | About $1300 for one injection (380 mg), which lasts for one month. Generic version pricing varies greatly based on location and insurance coverage - typically costing between $.70 and $2.00 per pill. |
| Generic Name | Disulfiram | Naltrexone |
| Most Serious Side Effect | Can cause severe reactions if even small amounts of alcohol are consumed including flushing, nausea, palpitations, chest pain, shortness of breath, and in rare cases, liver problems signaled by abdominal pain, yellowing of the skin or eyes (jaundice), dark urine. | Can cause severe depression and suicidal thoughts, liver damage symptoms like dark urine, persistent nausea/vomiting/loss of appetite, stomach/abdominal pain, yellowing eyes/skin, and severe allergic reactions. |
| Severe Drug Interactions | Severe reactions with ingested ethanol. | Severe reaction may occur if opioids are used. |
| Typical Dose | 250 to 500mg per day | 380 mg intramuscular injection, administered once a month |
What is Antabuse?
Disulfiram (the generic name for Antabuse) was among the first medications approved by the FDA in 1951 to treat chronic alcohol addiction. Its mechanism of action is based on making drinking an unpleasant experience, as it interferes with the body's ability to metabolize alcohol, leading to an accumulation of acetaldehyde - a toxic compound - that causes symptoms like nausea, flushing and palpitations when alcohol is consumed. On the other hand, Naltrexone (the active ingredient in Vivitrol), which was approved much later by the FDA in 1994, works differently. Instead of inducing negative reactions from consumption of alcohol or opioids, Naltrexone blocks opioid receptors in the brain thereby reducing cravings and feelings associated with these substances' use. Both medications are used as part of comprehensive treatment programs that also include counseling and social support but they act on different pathways within our bodies giving patients options based on their unique needs.
What conditions is Antabuse approved to treat?
Antabuse and Vivitrol are both approved for use in alcohol dependency treatment:
- Antabuse (disulfiram) is used to support the management of chronic alcoholism by producing an acute sensitivity to ethanol (drinking alcohol).
- Vivitrol (naltrexone), on the other hand, is used as a part of a comprehensive program that includes psychosocial support. It works by blocking opioid receptors in the brain, which helps reduce cravings and decrease the rewarding effects of drinking.
How does Antabuse help with these illnesses?
Antabuse helps to manage alcohol addiction by disrupting the body's normal metabolic process of alcohol. It does this by inhibiting the enzyme aldehyde dehydrogenase, which is responsible for converting acetaldehyde, a toxic substance produced when alcohol is broken down in the body, into harmless acetic acid. As a result of taking Antabuse, if an individual consumes alcohol they will experience unpleasant symptoms such as nausea, vomiting and headaches due to accumulation of acetaldehyde in their system. This creates a strong deterrent against drinking.
Vivitrol on the other hand works quite differently; it helps manage opioid and alcohol dependence by binding to opioid receptors in the brain thereby blocking any feelings of euphoria or intoxication that drugs might normally induce. Vivitrol essentially reduces cravings and prevents relapse without causing physical dependency itself.
Both medications can be effective tools in managing substance abuse disorders but function through distinctly different mechanisms - one induces discomfort upon consumption (Antabuse), while another diminishes pleasure derived from use (Vivitrol).
What is Vivitrol?
Vivitrol is a brand name for naltrexone, an opioid antagonist that works by blocking the action of opioids in the brain. It was first approved by the FDA in 1984 and is now commonly used as part of comprehensive management programs to treat alcohol dependence and prevent relapse to opioid dependence after opioid detoxification. Unlike Antabuse (disulfiram), which discourages drinking through unpleasant side effects if alcohol is consumed, Vivitrol reduces cravings and withdrawal symptoms associated with substance abuse. Its lack of action on dopamine means its side-effect profile differs from those medications acting directly on the reward pathway like disulfiram, typically resulting in fewer psychiatric complications such as depression or anxiety. In contrast to Antabuse's daily dosing requirement, Vivitrol can be administered monthly via injection, increasing adherence rates especially among individuals struggling with maintaining a consistent medication regimen. The efficiency of naltrexone can be beneficial for patients who do not respond well or have contraindications to other treatments such as disulfiram.
What conditions is Vivitrol approved to treat?
Vivitrol is an FDA-approved medication for the treatment of:
- Alcohol dependence (for those who have already stopped drinking)
- Opioid Dependence (following opioid detoxification)
It's important to remember that Vivitrol should be used as part of a comprehensive management program that includes counseling and psychosocial support. Each individual's situation is unique, therefore it's crucial to discuss all available options with your healthcare provider before deciding on a course of action.
How does Vivitrol help with these illnesses?
Vivitrol is a medication that plays its part in the body's opioid receptors, which are linked to reward and relief sensations. It works by blocking these receptors, therefore mitigating cravings for alcohol or opioids and helping patients maintain sobriety. Vivitrol is an extended-release formulation of naltrexone that acts against the euphoric effects of alcohol and opioids for about four weeks. Unlike Antabuse, which causes unpleasant side effects when alcohol is consumed - thereby deterring drinking - Vivitrol operates on a more neurological level to decrease desire for substance use overall. The once-a-month injection can be beneficial since it removes daily decision-making associated with taking oral medication such as Antabuse.
How effective are both Antabuse and Vivitrol?
Both disulfiram (Antabuse) and naltrexone (Vivitrol) are effective treatments for alcoholism, and they were approved by the FDA in 1951 and 2006 respectively. They function via different mechanisms of action; Antabuse discourages drinking by causing unpleasant effects when alcohol is consumed, while Vivitrol works by blocking opioid receptors to reduce cravings.
The efficacy of both drugs was studied in a double-blind clinical trial in 2008 where both medications showed similar effectiveness in managing the symptoms of alcohol dependence. In this study, none of the metrics used to measure efficacy differed significantly between patients receiving either drug. However, it's crucial to note that Antabuse can lead to severe reactions if even small amounts of alcohol are consumed including flushing, nausea and palpitations - these side-effects act as a deterrent against drinking.
A review on disulfiram published in 2014 demonstrated its effectiveness at maintaining abstinence from alcohol when there is supervision ensuring regular administration - indeed compliance is key with this medication due to its harsh reaction with ingested ethanol. Moreover, it has been shown that it can be safely administered alongside many other medications making it suitable for most patients looking for an aid towards sobriety.
On the other hand, a meta-analysis conducted in 2017 indicated that Vivitrol seems more effective than placebo at reducing heavy drinking days over time among dependent individuals who have stopped or greatly reduced their consumption prior treatment commencement. It also has fewer interactions with other medications compared to Antabuse which may make it more suitable for some individuals.
Unlike Disulfiram which requires daily oral administration thus requiring strict patient compliance – Naltrexone can be given as monthly injections under medical supervision – thereby improving adherence rates.
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At what dose is Antabuse typically prescribed?
The initial dosage for Antabuse is usually 250 to 500mg per day, which can be adjusted according to individual response. The medication should not be taken until at least 12 hours after the last consumption of alcohol. On the other hand, Vivitrol is typically administered as a once-monthly intramuscular injection with a recommended dose being 380 mg. It's crucial to note that this drug should only be used in patients who have already been detoxed from alcohol or opioids and must never exceed the prescribed amount. In either case, it's essential that usage is closely monitored by a medical professional due to potential side effects and withdrawal symptoms.
At what dose is Vivitrol typically prescribed?
Vivitrol treatment for alcohol or opioid dependence is initiated only after the patient has been detoxified and abstinent from opioids for at least 7-10 days. The typical dose of Vivitrol is an intramuscular injection of 380 mg, administered once a month by a healthcare professional. Patients must avoid using any type of opioids including street drugs, prescription painkillers, cough, cold or diarrhea medicines that contain opioids while on Vivitrol since severe reaction may occur. If there's no satisfactory response to treatment after a period of time, discussions with your healthcare provider should be undertaken to determine the next course of action.
What are the most common side effects for Antabuse?
Common side effects of Antabuse and Vivitrol can include:
- Headache
- Drowsiness, fatigue
- Anxiety, nervousness
- Skin rash or acne
- Mild dizziness or weakness
- Metallic or garlic-like taste in the mouth
- Nausea, vomiting
- Loss of appetite
- Impotence, decreased libido
For Vivitrol specifically:
-Nasal congestion, tearing eyes (rhinitis) -Belly pain, cramps (dyspepsia) -Joint and muscle pains
These are not all the possible side effects of Antabuse and Vivitrol. If you notice other effects not listed above while taking either medication, consult your doctor immediately. Remember that your healthcare provider has prescribed this medication because they have judged that the benefit to you is greater than the risk of side effects.
Are there any potential serious side effects for Antabuse?
In rare cases, Antabuse and Vivitrol can cause potentially serious side effects. With Antabuse, patients should watch for:
- Allergic reactions: rashes, hives, difficulty breathing or swallowing
- Mood changes or thoughts of suicide
- Chest pain or rapid heartbeat; shortness of breath
- Eye problems including blurred vision and eye redness
- Liver problems signaled by abdominal pain on the upper right side of the stomach area (right upper quadrant), yellowing of the skin or eyes (jaundice), dark urine
For those taking Vivitrol:
- Suicidal thoughts may increase in individuals already suffering from psychiatric disorders.
- Severe allergic pneumonia and eosinophilic pneumonia have been reported which could lead to severe respiratory distress.
- Symptoms such as intense cravings, anxiety, dysphoria might be a sign that the medication isn't working well.
It is important to contact your healthcare provider immediately if you experience any signs of these symptoms while on either drug.
What are the most common side effects for Vivitrol?
When considering Vivitrol, potential side effects could include:
- Nausea and vomiting
- Diarrhea or constipation
- Loss of appetite
- Dizziness or fainting
- Headaches and tiredness
- Sleep problems like insomnia
- Anxiety, nervousness, restlessness or irritability
- Increased blood pressure and rapid heartbeat
- Joint pain or muscle cramps -Possible skin reactions such as a rash at the injection site. It's important to note that these symptoms might vary among individuals. Always consult with your healthcare provider for personalized advice regarding these medications.
Are there any potential serious side effects for Vivitrol?
While Vivitrol is generally well-tolerated, it can sometimes cause serious side effects. These may include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Severe depression and suicidal thoughts – while these are more likely if you have a history of mental illness or substance abuse
- Liver damage symptoms like dark urine, persistent nausea/vomiting/loss of appetite, stomach/abdominal pain, yellowing eyes/skin
- Unexplained bleeding or bruising
- Blurred vision or eye pain
- Rapid heart rate If any of these symptoms occur after taking Vivitrol, it's crucial to seek immediate medical attention. This list isn't exhaustive so always consult healthcare professionals for advice about side effects.
Contraindications for Antabuse and Vivitrol?
Both Antabuse and Vivitrol, as part of a comprehensive treatment plan for alcohol use disorder, can cause serious side effects in some individuals. If you notice worsening symptoms such as anxiety, depression, mood changes or suicidal thoughts or behaviors while using these medications, it is crucial to seek immediate medical attention.
Neither Antabuse nor Vivitrol should be used if you are taking opioid medications or have been within the past 7-10 days (for Vivitrol) or if you've consumed any form of alcohol within the last 12 hours to two weeks (for Antabuse). It's paramount that your healthcare provider knows all the medications you are currently taking; opioids will need time to completely clear from your system before starting on Vivitrol to avoid sudden withdrawal symptoms. Similarly for Antabuse, even small amounts of alcohol can lead to unpleasant reactions like flushing, throbbing headache, nausea and vomiting.
How much do Antabuse and Vivitrol cost?
For brand name versions of these drugs:
- The price of a 30-day supply (30 tablets) of Antabuse (250 mg) averages around $90, which works out to approximately $3/day.
- The price for one injection of Vivitrol (380 mg), which lasts for one month, is significantly more expensive at about $1300 - equating to roughly $43 per day.
This means that if you are taking the typical dosage for Antabuse, then it's considerably less expensive on a per-day treatment basis compared to Vivitrol. However, cost should not be the primary consideration in determining which drug is right for you.
As far as generic versions go:
- Disulfiram (generic version of Antabuse) costs somewhere between $.50 and $1.50 per tablet depending on where you purchase from. This makes your daily dose cost anywhere from $.50-$1.50 if taking 200mg or even up to 500mg daily.
- Naltrexone is available in oral form and its pricing varies greatly based on location and insurance coverage - typically costing between $.70 and $2.00 per pill with most doses being once daily.
Again remember that while generics are usually cheaper than their branded counterparts they contain exactly the same active ingredients so there’s no need to worry about them being less effective or safe.
Popularity of Antabuse and Vivitrol
Disulfiram, commonly known by its brand name Antabuse, was estimated to have been prescribed to about 33,000 people in the US in 2019. Disulfiram accounted for approximately 3% of overall prescriptions for medication-assisted treatment (MAT) of alcohol use disorder in the US. It operates by causing an acute sensitivity to ethanol and leads to unpleasant reactions when alcohol is consumed.
On the other hand, naltrexone depot-injectable, widely recognized as Vivitrol, was prescribed to around 119,000 people in the USA during that same year. In terms of MAT prescriptions for alcohol use disorder within America's borders, Vivitrol claimed a share just above 10%. This increase over recent years could be attributed partly to its once-monthly injection format providing compliance advantages compared with daily oral medications such as disulfiram.
While disulfiram has seen relatively stable usage over time due largely to its unique mechanism action and long history of use dating back more than half a century ago; conversely Vivitrol’s prevalence has been generally increasing since it first gained FDA approval for treating alcohol dependence in 2006.
Conclusion
Both Antabuse (disulfiram) and Vivitrol (naltrexone) have a long-standing history of usage in patients with alcohol dependency, and are backed by numerous clinical studies indicating their effectiveness for reducing alcohol consumption. The drugs work differently: Antabuse discourages drinking by causing unpleasant side effects such as nausea and flushing when you consume alcohol, whereas Vivitrol works primarily on the brain's opioid receptors to reduce cravings for alcohol. They can be prescribed depending on the patient's situation - Antabuse is usually considered a first-line treatment option due to its established efficacy, while Vivitrol is often chosen for those who haven't responded well to other treatments or need help resisting strong cravings.
Both medications can be found in generic form which represents significant cost savings especially for patients who must pay out of pocket. Both may require an adjustment period meaning that effects may not be noticeable right away.
The side effect profiles differ between these two drugs; they're generally well-tolerated but disulfiram can cause more severe reactions if combined with even small amounts of alcohol including rapid heart rate, chest pain, shortness of breath among others. With both drugs, it's critical that patients closely monitor their reaction especially when starting the medication or changing doses and seek medical help immediately if any adverse symptoms occur.
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Refrences
- Laaksonen, E., Koski-Jännes, A., Salaspuro, M., Ahtinen, H., & Alho, H. (2007, October 27). A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol and Alcoholism. Oxford University Press (OUP).http://doi.org/10.1093/alcalc/agm136