Alcohol abuse disulfiram

Parenteral 100 mg/mL for IV injection Drugs for the Prevention of Alcohol Abuse Disulfiram (generic, Antabuse)... 

Disulfiram is the first-line therapy for alcohol abuse. Disulfiram (and caicium carbamide) prevent the metabolism of aicohoi by inhibiting the enzyme aldehyde dehydrogenase, leading to accumulation of acetaldehyde and subsequent unpleasant intoxication. The objective of disuifiram treatment is to create an aversion to aicohoi, rather than modulating its neurochemical effects. However, controlled clinical trials have yielded inconsistent results. 

Brewer C, Meyers RJ, Johnsen J Does disulfiram help to prevent relapse in alcohol abuse CNS Drugs 14 329-341, 2000... 

This reaction converts disulfiram, a therapeutic agent for the treatment of alcohol abuse, discussed in Section 17.3, to dithiocarb (diethylthiocarbamate), a substance that strongly binds metals and is used for the treatment of nickel carbonyl poisoning. 

A 47-year-old man with alcohol abuse took disulfiram (236). He developed a psychosis while taking it and for 2 weeks after. He stated that he had not taken alcohol. He was successfully treated with antipsychotic drugs. Afterwards it was discovered that his family history was positive for schizophrenia it is therefore possible that he was more vulnerable to develop psychosis due to disulfiram. 

A chronic alcoholic is in treatment for alcohol abuse. The drug disulfiram is prescribed for the patient. This drug deters the consumption of alcohol by which of the following mechanisms ... 

An effective but painful part of the treatment for alcohol abuse is to administer disulfiram, marketed under the name Antabuse. Disulfiram blocks the action of ALDH, preventing the conversion of acetaldehyde to acetic acid. The resulting buildup of acetaldehyde causes the patient to feel very sick almost immediately, making the next cocktail/or less appealing. The action of disulfiram was discovered accidentally when Danish pharmaceutical researchers who were taking the drug as an experimental treatment for parasitic diseases became very iU every time they consumed alcohol. 

Monitoring Perform baseline and follow-up LFTs (10 to 14 days) to detect hepatic dysfunction resulting from therapy. Perform a CBC and serum chemistries. Dependence and addiction Alcoholism may accompany or be followed by dependence on narcotics or sedatives. Barbiturates have been coadministered with disulfiram without untoward effects, but consider the possibility of initiating a new abuse. 

Of 52 patients with alcohol dependence/abuse who were given disulfiram 250 mg bd after food, six developed psychotic symptoms all had a mood disorder but no thought disorder (235). The psychotic symptoms remitted completely after withdrawal and a short course of antipsychotic therapy, except in one patient who had to be given lithium. 

Simultaneous abuse of cocaine and alcohol is common and alcohol reduces negative stimulant effects and potentiates highs. Disulfiram has therefore also been used to treat cocaine dependence, with the rationale that an inability to modulate the effects of cocaine with alcohol may reduce cocaine use. 

Higgins ST, Budney AJ, Bickel WK, Hughes JR, Foerg F (1993) Disulfiram therapy in patients abusing cocaine and alcohol. Am J Psychiatry 150 675-676... 

Disulfiram inhibits acetaldehyde dehydrogenase, the enzyme that metabolizes alcohol it is not used for amphetamine abuse. 

D. Other problems. Ethanol abusers sometimes intentionally or accidentally ingest ethanol substitutes such as isopropyl alcohol (see p 234), methanol (p 260), or ethylene glycol (p 194). In addition, ethanol may serve as the vehicle for swallowing large numbers of pills In a suicide attempt. Disulfiram (p 186) use can cause a serious acute reaction with ethanol. 

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