Disulfiram: Uses, indications and cautions when using

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Disulfiram is a medicine used to treat alcoholism. Disulfiram works by blocking an enzyme that breaks down alcohol in the body. This means that when people who are taking disulfiram drink alcohol, they will experience unpleasant symptoms known as “aldehyde reactions” that will gradually stop drinking.

1. What is disulfiram?

Disulfiram is a medication used to treat alcohol use disorders. The role of the drug Disulfiram is shown through its ability to prevent the breakdown of alcohol in the body. This leads to a build-up of a toxic alcohol-related compound called “reactive aldehyde,” which can make people who drink alcohol while taking this drug extremely uncomfortable. It is this response that helps encourage people to avoid alcohol while taking the drug.
Disulfiram will start working immediately after taking a dose and will continue to work for about 1-2 weeks after the last dose of the drug.

2. Things to note about the drug Disulfiram

People who start taking disulfiram should not take their first dose of the drug until at least 12 hours after their last alcohol intake.
If disulfiram is taken too soon after drinking alcohol it will cause a reaction that can lead to serious illness. Symptoms of this reaction include nausea and vomiting, severe headache, flushing, dizziness, sweating, and chest pain. In some cases, patients have also experienced shortness of breath, blurred vision, fainting, confusion and irregular heartbeat when taking disulfiram with alcohol or alcohol-containing products in general. Reactions may occur up to 2 weeks after discontinuing disulfiram. It is important to talk to your doctor or pharmacist to learn about drugs or foods that may contain alcohol and should be avoided while taking disulfiram.
Alcoholics also need to remember not to stop taking disulfiram even if they feel better. Only a doctor, pharmacist or alcohol addiction specialist can determine the appropriate duration of treatment for each situation. Unplanned discontinuation of disulfiram may increase the risk of relapse of alcoholism.
Patients with stimulant use disorders in general and alcoholism in particular are at high risk for depression and suicidal ideation. Accordingly, if you find yourself having any thoughts of self-harm, you should call the police, your doctor or go to the nearest emergency room.
Tell all doctors and pharmacists that you are taking disulfiram if you need to take any other medicines, especially over-the-counter medicines for cough and cold symptoms. These medicines may contain small amounts of alcohol which may interact with disulfiram.
The effects of disulfiram on the fetus when administered to a pregnant woman are not clear, it is likely that disulfiram crosses the placenta and may be transferred to the fetus. Reports of disulfiram use during pregnancy have reported some cases of birth defects; however, some of them are commonly associated with alcohol exposure during pregnancy. Accordingly, disulfiram should be used during pregnancy only if the benefit outweighs the risk to the fetus.
For women who are breastfeeding, because of the possibility that disulfiram will pass into breast milk and the effect of disulfiram on the baby is unknown, it is best to avoid taking Disulfiram during this period.

3. How to use Disulfiram?

Disulfiram oral tablet is usually taken once daily in the morning. In case the drug causes drowsiness, the patient can take the drug in the evening.
Taking disulfiram tablets with food may reduce abdominal discomfort. If you feel unable to swallow pills whole, you can crush them and mix them with water or juice.
People may be given a trial dose of 250mg per day to ensure tolerability. If tolerated at low doses, the dose can be increased to 500 mg daily.
Users should use a calendar, pill box, alarm clock or mobile phone alert to help remember to take their medication at the same time every day. In case you miss a dose of disulfiram, take it as soon as you remember unless it is almost time for your next dose. Do not double the next dose or take more than the prescribed dose.
While taking Disulfiram, it is necessary to avoid drinking alcohol as well as avoiding contact with products containing alcohol, such as rubbing alcohol, aftershave cleaners, some mouthwashes, perfumes, etc. hand sanitizer and some hair sprays. These products may contain an alcohol that can increase the effects of disulfiram and make the user feel nauseous. Note that certain food products, such as vinegar, kombucha, sauces, and some flavorings, may also contain alcohol and should be avoided.
In case of arbitrary overdose of Disulfiram, users will experience nausea, vomiting, dizziness, drowsiness, loss of coordination, abnormal muscle movements, decreased appetite, euphoria, inability to normal speech, convulsions, and coma. If this happens, call your doctor or go to the emergency room right away for timely intervention.

4. What are the possible side effects of Disulfiram?

To date, there are no known adverse events associated with long-term use of disulfiram. This is considered a safe and effective medication when used exactly as directed. However, like other drugs, Disulfiram can also have certain unwanted effects.
Common side effects of taking Disulfiram are drowsiness, headache, fatigue, acne or a feeling of a metallic aftertaste in the mouth.
Rare or serious side effects that have been reported are nerve pain or nerve damage, mental confusion, skin rash and changes in liver function or liver failure.
Disulfiram should not be used in people with cardiovascular disease because it will increase cardiovascular events.

5. What other drugs may interact with Disulfiram?

While taking disulfiram, it is very important to avoid products that contain alcohol, such as cough and cold syrups, pain relievers, tonics and some muscle relaxants. If taken with disulfiram, these products can cause nausea, vomiting, sweating, and headaches and in rare cases can lead to shortness of breath and irregular heartbeat. It's best to tell your doctor or pharmacist before starting any new medication, either over-the-counter or prescription, while taking disulfiram.
When taken with a cannabinoid medicine called dronabinol (Syndros®), disulfiram can cause stomach cramps, nausea, vomiting, and headaches. Therefore, disulfiram should not be taken within 14 days of taking this medicine.
Disulfiram may increase blood levels of phenytoin, a medicine used to treat seizures, which may increase side effects.
Some antibiotics or HIV medicines, such as metronidazole , ritonavir or lopinavir, can increase the side effects of disulfiram if taken in combination.
Taking disulfiram with the antibiotic isoniazid can make the user unsteady. Accordingly, care should be taken when standing, walking and driving, operating machinery if taking this drug in combination.
Disulfiram may increase the effects of blood thinners, increasing the risk of bleeding. Therefore, consult your doctor about reducing the dose of blood thinners when taking disulfiram.
In summary, the drug Disulfiram is a drug used with the goal of alcohol withdrawal. It is important to remember that this is not the only way that the drug's effectiveness will be optimal when used in conjunction with other treatments and counseling. In some cases, Disulfiram may be more appropriate for people who have gone through withdrawal and have stopped drinking as a means of preventing further drinking. Accordingly, it is necessary to adhere to the dosage and the notes when taking the drug to achieve long-term goals.

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References: webmd.com, nps.org.au, sahealth.sa.gov.au