Disulfiram therapy - Useful for both UG & PG Students

1. NITHIYANANDAM. T
MSN, I YEAR,
CON, MTPG &RIHS.

2. Deterrent agents are
given to desensitize
the individual to the
effects of alcohol &
Abstinence.
The Most commonly
Used Drug is
Disulfiram or
Tetraethyl thiuram
disulfide or Antabuse.

3. Disulfiram (tetraethyl thiuram disulfide) was
discovered in 1930s, when it was observed
that workers in the rubber industry
developed unpleasant reactions to alcohol
intake, due to accidental absorption of
antioxidant disulfiram.

4. Disulfiram is used to
ensure Abstinence in the
Treatment of Alcohol
Dependence. Its Main
effect is to Produce a
rapid & Violently
Unpleasant Reaction in a
Person who ingests even
a Small amount of
alcohol While Taking
Disulfiram.

5.  Disulfiram is a medicine used in the long
term treatment of patients with alcohol
misuse.
 It produces extremely unpleasant reactions
in a person who ingests even a small amount
of alcohol while taking Disulfiram.
 This effect is used in the treatment of
patients with alcohol problems.
 It’s Chemical name is Tetraethylthiuram
disulfide

6.  The knowledge that taking alcohol will be
unpleasant serves as a reinforcement or
additional support to their decision not to
drink.
 It also Protects them from giving in to sudden
urges to drink, or pressure from friends.
 It is supplied in tablets of 250mg. The ususal
dosage ranges from 125 to 500mg a day. The
dosage should not usually exceed 500mg a
day.
 It should be taken before bed time to avoid
drowsiness in day time.

7.  Disulfiram is completely absorbed from
the stomach after oral administration.
 It is broken down in the liver & excreted in
the urine.
 One or two weeks may be needed before
disulfiram is totally eliminated from the
body after the last dose has been taken.
 So the disulfiram effect may last up to two
weeks.

8. Generally Disulfiram is not used in:
 Children
 Pregnant Women
 Recent “Heart Attack”
 Liver Damage (Cirrhosis of Liver & Acute Hepatitis)
 Fits (Epileptic Seizures)
 Psychosis
 Major Depression
 Recent Stroke
 Patients Unwilling to take, or those who do not know
that they are being given.

9. In some people, Disulfiram in the absence of
alcohol can produce:
 Lethargy, Drowsiness – 45%
 Decreased Memory – 40%
 Headache – 35%
 Itching – 33%
 Decreased Sleep – 27%
 Dizziness – 22%
 Sexual Problems – 10%

10.  Peripheral Neuropathy – Tingling &
Numbness of hands & Legs.
 Worsening Depression & Psychosis in
some patients.
 Less than 10 patients out of a 100 taking
disulfiram, develop serious side effects
which require withdrawal of the drug.

11.  Disulfiram interferes with the normal
breakdown of alcohol in the body by producing
a marked increase in a normal breakdown
product of alcohol called Acetaldehyde.
 The increase in the acetaldehyde is 10 times
higher than in the normally occurring
metabolism of alcohol. The accumulation of
acetaldehyde produce a vast array of
unpleasant reactions. This is the so called
Disulfiram – Alcohol Reaction. The reactions are
Characterized by:

12.  Throbbing headache
 Facial flushing
 Blurring of vision
 Giddiness
 Chest Pain
 Difficulty in Breathing
 Nausea & Vomiting
 Sweating
 Thirst
 Low Blood Pressure & Shock – Which untreated may
rarely lead to death.
The reaction occurs almost immediately after the
ingestion of just one drink.

13. It is an Aldehyde Dehydrogenase inhibitor that
interferes with the metabolism of alcohol & Produces
a marked increase in blood acetaldehyde levels.
Accumulation of acetaldehyde( more than 10 times
which occurs in the normal metabolism of alcohol)
produces a wide array of Unpleasant reactions Called
DISULFIRAM-ETHANOL REACTION (DER).
Characterized by Nausea, Throbbing headache,
Hypotension, Sweating, thirst, Chest Pain,
tachycardia, Vertigo, blurred Vision associated with
Severe Anxiety.

15.  Even a small amount of alcohol will bring on the
unpleasant Disulfiram – Alcohol Reaction.
 The person taking Disulfiram should not use or
have the Alcohol containing preparation such as:
Cough Syrups, Vitamin Tonics, Ayurvedic Tonics,
After Shave lotion, Perfumes, Spirits, Spirit based
Paints, glues, thinners, etc., and Stale or fermented
foods.
 The Disulfiram – Alcohol Reaction may occur as
long as one or two weeks after the last dose of
disulfiram.

16.  Some patients hear false information
regarding the Disulfiram – Alcohol Reaction.
It does not cause:
Vomiting Blood
Passing blood in the urine or Stool
Swelling all over the body
Going Mad
Going Blind
 The above symptoms usually will not occur in
Disulfiram – Alcohol Reaction.

17. Disulfiram helps a person:
 To start a period of being SOBER.
 To give cover over a high risk period.
 To resist impulses to drink.
 To reduce drinking days.
 To help the organs recuperate & the individual
to change his life style.
 (By prolong abstinence a person can learn new
coping skills & the damaged organ can return
to normal state).

18.  For long term recovery & to learn new ways
of coping with life, a period of abstinence
needs to be at least 1 & probably 2 years.
 So it is appropriate to take disulfiram tablet
for at least 6 months & probably upto 2
years.

19.  It is convenient to take disulfiram in the
morning hours after coffee or breakfast.
 Disulfiram treatment is more effective if
supervised by the wife of the patient or a
close family member.
 Taken before bed time to avoid drowsiness.
 Effective begins within 12 hours first dose
remains 7 – 10 days after last dose.

20.  The person is highly motivated.
 Daily use of disulfiram under supervision.
 Abstinence prior to treatment.
 Regular contact with the doctor or treating
team.

21.  The patient should always carry identification
cards describing the Disulfiram – Alcohol
Reaction.
 If any person develops Disulfiram – Alcohol
Reaction:
Stop Disulfiram.
Immediately go to the near by doctor and show
the card.
For further information, they can contact duty
psychiatrist.

22. If Disulfiram – Alcohol Reaction is severe, the
person might need admission to a hospital or
nursing home so that his pulse and blood
pressure can be monitored and symptomatic
treatment with intravenous fluids may be given.
Inj. Avil for the allergic reaction and dopamine to
elevate the blood pressure may be required
according to the patients symptoms.

23.  An informed Consent should be taken before
Starting treatment.
 Ensure that at least 12hours have elapsed since
the last ingestion of Alcohol before Administering
the Drug.
 Patient should be warned against Ingestion of any
alcohol-containing preparations such as Cough
Syrups, Sauces, Aftershave Lotions, Etc.,
 Caution patient against taking CNS Depressants
& Over-the-Counter(OTC) Medications during
disulfiram therapy.
 Instruct The Patient to avoid driving or other
activities requiring alertness.

24.  Patients should be warned that the Disulfiram-
alcohol Reaction may continue for as long as
1or 2 weeks after the last dose of disulfiram.
 Patients should carry identification cards
describing Disulfiram-alcohol reaction & listing
the name & phone number of the physician to
be called.
 Emphasize the Importance of Follow-Up visits
to the physician to monitor progress in long-
term therapy.