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Disulfirame

Disulfirame

Disulfirame

Disulfiram blocks the enzyme aldehyde dehydrogenase (ALDH) involved in the removal of alcohol, resulting in an increase in the concentration of acetaldehyde, a toxic intermediate. The aversive effect of the interaction following the intake of alcohol ("flush") is supposed to prevent the patient from continuing to drink. In sensitive people, this reaction may even be triggered by low amounts of alcohol (eg, wine vinegar in salad, alcoholic deodorants, shaving lotion, etc.). Conversely, others can drink large quantities of alcohol without major problems.

The "Antabus reaction test" carried out in the past (only in Switzerland: the patient ingested alcohol under strict medical control after three days of Antabus) served among other things to determine this sensitivity, but also to concretely demonstrate the very unpleasant effects that could occur. Almost all doctors have today abandoned this practice clearly discouraged by the manufacturer itself.

Dosage

Disulfiram should be started after 2 to 3 days of complete abstinence from alcohol. The usual dosage is 200 mg daily.

Cons-indications

  • Psychiatric comorbidity pronounced especially in case of marked impulsivity at the symptomatological level
  • Liver function disorders (transaminases, alkaline phosphatase, GGT> 3 times higher than normal)
  • Epilepsy
  • Peripheral polyneuropathy
  • Pregnancy
  • Renal or cardiac disorders

Warnings

Cases of severe hepatic toxicity that may require liver transplantation or death have been reported: In the case of signs suggestive of asthenia, anorexia, nausea, vomiting, abdominal pain or jaundice, clinical examination and biological control of liver function should be undertaken immediately.

The disulfiram-alcohol reaction: this reaction (antabuse effect) occurs in patients treated with disulfiram during the absorption of alcohol, even in small quantities: beware of the presence of alcohol in the composition of other drugs ( especially in oral solutions), in the diet, but also when using toiletries such as aftershaves and perfumes.

Unpleasant symptoms (flushing, erythema, nausea and vomiting, feeling sick, tachycardia, hypotension) occur 10 minutes after ingestion of alcohol and last from 1/2 hour to several hours.

Pregnancy and breast feeding

Animal data are inconclusive and clinical data is insufficient. The use of disulfiram is therefore not recommended during pregnancy, whatever the term, and in women of childbearing age who do not use contraceptive measures. The appearance of a strong antabuse effect when drinking alcohol can have serious consequences for the fetus. When treated with disulfiram, breast-feeding is not recommended.

Side effects

  • Nausea, vomiting, gastralgia, diarrhea
  • Metallic aftertaste in the mouth; bad breath
  • Unpleasant odor in colostomized patients

Elevations of transaminases are common. Cases of hepatitis (mainly cytolytic) are reported; some severe cases are accompanied by hepatic insufficiency or fulminant hepatitis that may warrant liver transplantation or death. ( see section Warnings and precautions for use ).


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