Disulfiram (Antabuse)
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The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter. The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.
Disulfiram at one time was the main medication endorsed for the treatment of alcohol abuse issues.
For over 60 years, individuals recouping from alcoholism have taken disulfiram or the brand name Antabuse to diminish their cravings for alcohol.
Differently from the medication acamprosate, disulfiram does not treat alcoholism by lessening yearnings.
Its effects are cognitive. Disulfiram and Antabuse are utilized to demoralize alcohol utilization.
The medications cause antagonistic reactions, for example, perspiring, chest agony, and queasiness, when alcohol is introduced into the system.
Individuals who take disulfiram end up preferring not to encounter the horrendous side effects, so they end up being trained not to drink.
The reactions are brought about by acetaldehyde, a toxic substance that is created when the body utilizes alcohol.
Disulfiram disturbs the manner in which the body separates alcohol, causing acetaldehyde levels to develop.
Devouring high doses of alcohol in the wake of taking enormous doses of disulfiram can bring about serious symptoms and dangerous reactions.
The disulfiram name contains a black box cautioning, the most serious U.S.
Food and Drug Administration cautioning, about the dangers of the medication and its potential to be fatal if taken with alcohol.
In spite of the fact that the medication is still utilized by certain advisors, it has lost ubiquity due to poor consistency.
It is most effective when taken by individuals who are inspired to keep up moderation and regulated by a specialist or life partner.
Like other medications aimed at combating alcoholism, disulfiram is increasingly successful when it’s taken in tandem with other treatments that treat the fundamental reasons for alcoholism.
The medication does not cause resilience and can be taken until long term balance or acceptance of sobriety is kept up.
Many individuals have taken disulfiram years. A few people in long term recuperation take the medication when they envision a high-hazard circumstance or need may occur.
How Disulfiram Works
Disulfiram interferes with the manner in which the body utilizes alcohol, causing terrible reactions.
This reaction disheartens patients from drinking and increases their inspiration to support collectedness.
However, the physical effects can be unpredictable, and it’s hard to foresee exactly when they will happen.
Reactions to alcohol, for the most part, start somewhere in the range of 10 and 30 minutes after an individual beverage.
The seriousness of the response relies upon a few different caveats but the most crucial are, the dosage of disulfiram taken, and the amount of alcohol consumed.
Regular reactions
Regular reactions brought about by disulfiram and alcohol include:
· Perspiring
· Flushed skin
· Inconvenience relaxing
· Obscured vision
· Thirst
· Sickness
· Heaving
· Chest torment
· Throbbing in the neck or head
· Vertigo
· Disarray
· Shortcoming
High doses of disulfiram and alcohol can cause extreme reactions, including respiratory failure, heart arrhythmia, seizure, heart attack, or liver failure.
Extreme reactions are incredibly unlikely when disulfiram is taken as prescribed.
The reactions generally maintain for somewhere in the range of thirty minutes to an hour, however serious reactions can last a few hours.
It can take the body as long as about fourteen days to consume alcohol without a reaction after the last portion of disulfiram is administered, so people who drink alcohol during that timeframe may encounter reactions.
Other side effects, even when alcohol is not being consumed, include:
- Cerebral pain
- Tiredness
- Skin inflammation
- Weakness
- Metallic preference for the mouth
- Skin rash
In the event that symptoms proceed or become progressively more serious, patients should speak with their health care provider.
Interactions and Warnings
A few people should never take disulfiram, and others should utilize additional alert when taking the medication.
Try not to take disulfiram in the event that you have a nickel sensitivity, a sulfur hypersensitivity, or an allergy to disulfiram or different subsidiaries of thiuram, which are normally found inelastic.
Patients with the accompanying conditions or conditions should be mindful when taking disulfiram:
PSYCHOSIS
Patients with a background marked by psychosis should take disulfiram only when they are not in a psychotic episode.
Serious MYOCARDIAL DISEASE OR CORONARY OCCLUSION
Disulfiram should be utilized only when the danger of alcohol utilization exceeds the danger of interactions with these conditions.
PREGNANCY
The hazard to the infant is unsure, and inpatient substance abuse recovery is a favored treatment approach over disulfiram for pregnant women with alcohol use issues.
Women who are nursing should not take disulfiram.
Mothers can take a physician recommended prescription once they finish nursing.
Disulfiram may interact with a few other medications, changing their adequacy or causing antagonistic reactions.
Medications known to interface with disulfiram include:
- Coumadin (warfarin)
- Dilantin (phenytoin)
- Elavil (amitriptyline)
- Flagyl (metronidazole)
- Isoniazid
- Librium (chlordiazepoxide)
- Norpramin (desipramine)
- Rifadin (rifampin)
- Theophylline
- Tofranil (imipramine)
- Tricyclic antidepressants
- Valium (diazepam)
Prior to taking disulfiram, patients should tell their doctor any background of coronary illness, kidney infection, thyroid issues, epilepsy, liver malady, diabetes, or a background marked by psychological wellness concerns.
Some frequently asked questions about Disulfiram are:
Who Should Take Disulfiram?
Disulfiram should never be taken by people impaired by alcohol.
Disulfiram is recommended distinctly to individuals who have not consumed any alcohol for at least twelve hours prior to the first dose of the medication.
Different reasons for disulfiram to be incorporated into an individual’s treatment plan are:
– Focus on sobriety
– Mindfulness of the outcomes of drinking while at the same time taking disulfiram
– An openness to taking it with supervision
– A change in conditions or medications that previously restricted its use
Specialists instruct patients about the dangers of blending alcohol with disulfiram before recommending the medication.
They may complete a breathalyzer test, other physical tests, or a pregnancy test to guarantee disulfiram use is recommended.
While some health care providers may not require specific and consistent utilization of disulfiram when prescribing, most specialists and advisors recommend it be administered along with other substance abuse treatment to encourage consistency.
The vast majority start with a 250 mg portion taken once every day for about fourteen days.
The smallest useful dosage is 125 mg, and the most maximum dosage should not exceed 500 mg.
On the off chance that patients miss a portion, they should not double up their dosage the next time they take the medication.
The medication is accessible in tablet form in the United States.
Does Disulfiram help alcoholics stay sober?
The viability of disulfiram treatment is impacted by consistency and inspiration for treatment.
The principal experiment of the use disulfiram treatment for alcohol reliance utilized high doses (somewhere in the range of 1,000 and 3,000 mg day by day) to guarantee solid reactions to alcohol.
The researchers needed to know whether individuals with alcohol use issues could be molded to keep away from alcohol in the event that they were presented to upsetting reactions when they drank.
Be that as it may, the dependence treatment network moved away from revulsion treatment on account of the serious reactions related to high doses of disulfiram and alcohol.
Today, disulfiram is still used in some instances to help with forbearance.
Directed utilization of disulfiram is related to higher paces of restraint than solo treatment, as per a 2014 meta-examination distributed in PLoS One.
Court-requested treatment that requires administered utilization of disulfiram has been shown to build consistency, as per a recent report.
Social help, supervision from a companion, conduct treatment, and building up an agreement with a patient may likewise expand the adequacy of disulfiram.
A few specialists have pulled back from disulfiram use due to lack of consistency, particularly in outpatients and high risk patients.
The utilization of the medication has likewise been scrutinized due to the genuine symptoms and reactions related to it.
When disulfiram is taken in the correct doses, the danger of genuine symptoms is unlikely.
However, people taking any medication should know about its dangers.
With supervision, disulfiram and Antabuse can help in the recuperation from alcoholism.
What should I discuss with my healthcare provider before taking Disulfiram?
– Side effects of your condition that trouble you
– In the event that you have hypersensitivities to any prescriptions
– If you are having or have had contemplations of suicide or self-harm
– Medication you have taken in the past for your condition, regardless of whether they worked or brought on any antagonistic effects
– If you experience reactions from your medication. Some reactions may not be cause for worry, others may require changes in medicine.
– Any other mental or clinical issues you have, including liver sickness
– Every single other prescription you are as of now taking (counting over-the-counter items, herbals, and homeopathic enhancements)
– Other non-drug medications you are participating in, for example, talk treatment. Your healthcare provider can clarify how these various therapies work with the drug.
– If you are pregnant or plan to become pregnant,
– If you utilize illicit medications or opiates
By what method should I take Disulfiram?
Disulfiram oral tablets are typically taken once a day in the morning.
In the event that you can’t swallow the tablet, you may break it up and blend or mix it into liquids.
On the off chance that the drug causes you to feel lethargic, it can be taken at night.
Taking disulfiram tablets with food may decrease stomach upset.
People may be given a test dose of 125 mg daily to ensure they can tolerate the medication.
If the low dose is tolerated, the dose can be increased to 500 mg daily.
Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication.
You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.
What happens if I miss A dose of Disulfiram?
If you miss a dose of disulfiram, take it as soon as you remember unless it is very close to the time of your next dose.
Do not double your next dose or take more than what is prescribed.
What should I avoid while taking Disulfiram?
Avoid consuming alcohol while you are taking disulfiram.
You should also avoid exposure to alcohol-containing products, such as rubbing alcohol, aftershave, certain mouthwashes, perfumes, hand sanitizers, and some hair sprays.
These products may contain a type of alcohol that can increase the effects of disulfiram and make you feel sick.
Be aware that certain food products, such as bottles of vinegar, kombucha, sauces, and some flavorings, may also contain alcohol and should be avoided.
Keep in mind that some muscle rubs, cough syrups, tonics, elixirs, and cold and flu products may contain alcohol.
Discuss all medications with your doctor and pharmacist prior to taking disulfiram and before starting new medicines.
What happens if I overdose with Disulfiram?
Disulfiram overdose may be associated with nausea, vomiting, dizziness, drowsiness, loss of coordination, unusual muscle movements, decreased appetite, excitement, inability to speak normally, seizure, and coma. If an overdose occurs, call your doctor or 911.
You may need urgent medical care. You may also contact the poison control center.
Are there any risks for taking Disulfiram for long periods of time?
To date, there are no known problems associated with long term use of disulfiram.
It is a safe and effective medication when used as directed.
Want to learn more about Disulfiram?
Here are some books on the topic:
Antabuse Treatment For Alcoholism
This pocket-sized textbook tells physicians, nurses, psychologists and counsellors who deal with the social, medical and psychological consequences of alcoholism, everything they need to know about disulfiram.
Disulfiram: Its Use in Alcohol Dependence and Other Disorders
This book focuses on the value of supervised Disulfiram therapy, highlighting the many potential and unique benefits of Disulfiram.
One of the oldest drugs available for the long-term management of alcohol dependence, Disulfiram remains a viable treatment option for alcohol dependence and has been shown in recent studies to be more successful in treating patients with alcohol dependence than Naltrexone, Topiramate and Acamprosate.
It is also useful in dual diagnosis patients and those with co-morbid cocaine and alcohol dependence.
Although Disulfiram’s mechanism of action in alcohol dependence was long thought to be its effects as a psychological deterrent, more recent studies point to potential anti-craving effects as well.
References
· Martin, B.K. et al. (2004, April). Adherence to court-ordered disulfiram at fifteen months: a naturalistic study. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pubmed/15063918
· National Institute on Drug Abuse. (2012, December). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved fromhttps://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapi-1
· Skinner, M.D. et al. (2014, February). Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919718/
· Substance Abuse and Mental Health Services Administration. (2009). Incorporating Alcohol Pharmacotherapies Into Medical Practice: Chapter 3—Disulfiram. Retrieved fromhttps://www.ncbi.nlm.nih.gov/books/NBK64036/
· The HAMS Reduction Network. (n.d.). What Is Acetaldehyde? Retrieved fromhttps://hams.cc/acetaldehyde/
· U.S. Food and Drug Administration. (n.d.). Disulfiram – disulfiram tablet. Retrieved fromhttps://edkb.fda.gov/webstart/arraytrack/PDFfile/LTKB_BD/disulfiram.pdf
· U.S. National Library of Medicine. (2012, February 11). Disulfiram. Retrieved fromhttps://medlineplus.gov/druginfo/meds/a682602.html
· U.S. National Library of Medicine. (2017, August 1). Disulfiram (By mouth). Retrieved fromhttps://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009996/?report=details
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