Disulfiram 

Overview

The first drug licensed by the US Food and Drug Administration to treat alcoholism was disulfiram. There are now three other drugs that have been authorized in the US for alcohol dependency. Disulfiram   should only be administered to a limited number of people who are well aware that it causes a strictly enforced sobriety requirement and for those who have a strong desire to abstain. Disulfiram   does not, by any means, treat alcoholism. To have any effect on the chronic alcoholic’s drinking patterns, it has to be taken in combination with a program that incorporates counseling and group support therapy.

The liver’s enzyme responsible for breaking down alcohol (ethanol) is blocked by Disulfiram, which leads to an accumulation of the metabolite acetaldehyde. A buildup of acetaldehyde causes symptoms including flushing, nausea, vomiting, headache and tachycardia. When using Disulfiram   on a regular basis, deliberate alcohol intake or inadvertently, may cause a disulfiram response, which is another name for the same symptoms. The possibility of experiencing this negative outcome deters drinking and encourages abstention.

A thorough medical history from the patient should be obtained by the doctor prior to writing a Disulfiram   prescription. If the patient has ever had a stroke, diabetes mellitus, liver illness, heart disease, or seizures, the Disulfiram   shouldn’t be given to the patient. It is imperative that the doctor provide the patient a comprehensive explanation of a disulfiram response; caregivers or family members must be informed as well. It is strongly advised that the patient sign an informed consent form attesting to their understanding of the potential negative effects of alcohol use and their assumption of responsibility for abstaining from alcohol entirely.

Information about Dosing

The patient should wait at least 12 hours after quitting alcohol before starting or continuing to take Disulfiram. The typical dose is 250 mg taken in the morning once a day. If the patient needs daytime sedation, they may take the dosage at bedtime is an issue. For the first one to two weeks, some doctors may start Disulfiram   at 500 mg/day and subsequently lower the dose. The maintenance dose should not exceed 500 mg per day and might vary from 125 mg to 500 mg per day. 

Typical Side Effects

Few negative effects occur when Disulfiram   is used without alcohol. Patients have sometimes reported mild acne, headache, nausea, sleepiness, sedation, fatigue, or metallic flavor. These adverse consequences are typically minor and go away with further treatment or a lower dose.

Adverse Events and Safety Measures

When alcohol is used in conjunction with Disulfiram, even modest quantities might cause a response similar to an awful hangover. Among the symptoms include flushes, palpitations, throbbing headaches, nausea, and severe vomiting, perspiration, lightheadedness, dyspnea, and hypotension, or low blood pressure. The length, degree of intensity and the quantity of alcohol consumed and the level of Disulfiram   in the bloodstream determine the outcome. The response may persist for a few hours in more severe responses, or for thirty to sixty minutes. Rarely and in very severe responses, Disulfiram   may cause mortality, convulsions, arrhythmias, and heart attacks.

Patients also need to be informed that alcohol may sometimes be found in meals and drugs.
Before using any product that could contain alcohol, always read the label. the alcohol basis included in liquid cold and cough remedies is sufficient to cause a disulfiram response at standard dosages. Disulfiram   usage has been linked to incidents of liver damage that have been documented. Sometimes, the liver errors were lethal. The patient’s liver function will be observed by the doctor while the patient is on Disulfiram   via laboratory testing and cease the drug if there’s any sign that Disulfiram ‘s effects are having an adverse effect on the liver.
The patient should inform the doctor of any indications or symptoms, such as weariness, of a liver issue, nausea, vomiting, jaundice (yellowing of the skin or eyes), or black urine. This might be a sign of a liver issue.

Utilization during pregnancy and nursing: Category C

Pregnant women have not participated in studies to evaluate the safety of Disulfiram. Women who are pregnant or want to become pregnant shouldn’t take Disulfiram. A disulfiram response may put the mother’s and the fetus’ life at jeopardy.
The excretion of Disulfiram   in breast milk is unknown. Disulfiram   should not be taken by nursing moms.

Potential Interactions with Drugs

Certain drugs may have their metabolism hampered by Disulfiram. Combining Disulfiram   with other medications may increase the impacted medications’ plasma levels and might result in toxicity. 

It is recommended that patients speak with their doctor or pharmacist prior to using any over-the-counter drugs or herbal remedies. When they relapse and start drinking again, they should let their doctor know, but they shouldn’t give up. using Disulfiram   without first talking to their doctor is not recommended. 

• Disulfiram   may amplify Coumadin’s anticoagulant impact. Keep a close eye on anticoagulation, and modify Coumadin if necessary. Keep an eye out for bruises or blood. 
• Benzodiazepines Disulfiram   interacts with several benzodiazepines (such as Valium, Librium, and Xanax). can slow down their metabolism and make them feel drowsier. A lower dosage of the benzodiazepine could be necessary for coadministration.
• Phenytoin, or Dilantin, Disulfiram   may obstruct Dilantin’s metabolism, which might lead to increased plasma phenytoin levels and potential Dilantin toxicity. 
• (Metronidazole) Flagyl Disulfiram   and Flagyl co administration has been shown to result in bafflement and severe insanity. These two drugs ought not to be combined. 
• Theophylline (For instance, Theo-Dur), Disulfiram   may cause disruptions to theophylline and perhaps intensify its harmful consequences. Observe theophylline carefully, and change the dose as needed.
• Tricyclic depression medicines (For instance, Elavil), Disulfiram   and tricyclic antidepressants have been administered together said to result in reduced mental capacity, confusion, and psychosis and fusion. The elderly might be more vulnerable to this side effect when using Disulfiram   with a tricyclic antidepressant.

overindulgence

Disulfiram   overdose has the potential to be harmful. The quantity consumed determines how harmful it is. the patient’s weight, age, and whether or not they have taken any other drugs. The security of Disulfiram   It is unclear whether youngster’s overdose.

Treating any suspected overdose as an emergency is imperative. The individual has to be brought to the emergency space for care and observation. It is advisable to bring the prescription bottle of medicine (as well as any additional medication that may have been taken in excess) since the information on the label may be useful in helping the treating physician figure out how many tablets the patient has taken.

Particular Points to Remember

• Typically, Disulfiram   is taken once a day or as prescribed by a doctor. Take the missed dosage as soon as you remember. If the next dose is almost here, skip the one you missed and go on with your normal dosage timetable. Avoid taking two doses at once.
• Always make sure that meals and drugs don’t include alcohol. Alcohol, even found in topical preparations like aftershave lotion, has the potential to penetrate the skin and cause a disulfiram response.
• Only when group therapy is a part of the overall treatment plan will alcohol misuse result in the maintenance of abstinence and assist with counseling and treatment.
• Don’t give up if you relapse; talk to your doctor, therapist, or counselor about your drinking. As instructed, keep taking Disulfiram, and get in touch with your doctor very far away.
• Speak with your doctor if you have any depressive symptoms, especially if you’re thinking about taking your own life. instantly consult a therapist or counselor.
• Keep the medicine out of direct sunlight and dampness, in the light-resistant container that came with it. Warmth and Moisture may hasten the disintegration of your prescription and cause it to lose its medicinal benefits.
• Make sure kids can’t get to your medicine.