Disulfiram: A Clinically Proven Alcohol Dependence Treatment
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Synonyms | |||
Disulfiram is a prescription medication designed to support the treatment of chronic alcohol dependence by creating a physiological deterrent to alcohol consumption. It functions as an aversive therapy, inducing unpleasant effects when alcohol is ingested, thereby helping patients maintain abstinence as part of a comprehensive treatment plan that includes counseling and psychosocial support. Administered under medical supervision, disulfiram is intended for motivated individuals committed to long-term sobriety.
Features
- Active ingredient: Disulfiram 250 mg or 500 mg tablets
- Mechanism of action: Inhibits aldehyde dehydrogenase, leading to acetaldehyde accumulation upon alcohol intake
- Administration: Oral tablet, once daily
- Prescription status: Schedule IV controlled substance in some regions
- Available formulations: Scored tablets for dose adjustment
Benefits
- Supports abstinence by creating a strong physiological aversion to alcohol
- Provides a tangible psychological reinforcement for commitment to sobriety
- Reduces alcohol craving in some patients through conditioned response
- Integrates effectively with behavioral therapy and support programs
- Helps re-establish normal metabolic patterns in chronic alcohol users
- May contribute to improved liver function with sustained abstinence
Common use
Disulfiram is indicated as an adjunct in the management of selected chronic alcohol-dependent patients who want to remain in a state of enforced sobriety. It is prescribed for motivated individuals who are simultaneously participating in a supportive psychotherapy program and who understand the consequences of alcohol consumption while taking the medication. The drug is typically initiated after the patient has been alcohol-free for at least 12 hours and preferably after comprehensive medical evaluation.
Dosage and direction
The initial dosage is typically 500 mg daily for one to two weeks, administered as a single dose in the morning. Maintenance dosage is usually 250 mg daily (range 125-500 mg). The dosage should not exceed 500 mg daily. Tablets should be swallowed whole with water, preferably at the same time each day. Treatment should continue until the patient is fully recovered socially and a basis for permanent self-control is established. The duration of therapy must be individualized and may continue for months or even years.
Precautions
Patients must be fully informed about the disulfiram-alcohol reaction and must give their informed consent before starting therapy. The reaction can occur up to 14 days after the last dose of disulfiram. Patients should carry an identification card stating they are taking disulfiram. Use with caution in patients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic impairment, or cardiovascular disease. Regular liver function tests are recommended during therapy. Patients should avoid alcohol in all forms, including medications, foods, and toiletries that may contain alcohol.
Contraindications
Disulfiram is contraindicated in patients with severe myocardial disease or coronary occlusion, psychoses, hypersensitivity to disulfiram or other thiuram derivatives, and those who are receiving or have recently received metronidazole, paraldehyde, alcohol, or alcohol-containing preparations. It should not be used during pregnancy unless clearly needed, and is not recommended for nursing mothers. The drug is contraindicated in patients without their full knowledge or consent.
Possible side effects
In the absence of alcohol ingestion, side effects may include drowsiness, fatigue, impotence, headache, acneform eruptions, allergic dermatitis, metallic or garlic-like aftertaste, and peripheral neuritis. Psychotic reactions have been reported. Hepatitis, sometimes fatal, has been reported rarely. Optic neuritis and peripheral neuropathy may occur. The most significant side effects occur with alcohol ingestion and include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitations, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion.
Drug interaction
Disulfiram may increase blood levels and prolong the action of drugs metabolized by hepatic microsomal enzymes, including warfarin, phenytoin, isoniazid, and certain benzodiazepines. Concurrent use with alcohol-containing preparations (including some cough syrups, tonics, and elixirs) will produce a disulfiram-alcohol reaction. Use with metronidazole may cause psychotic reactions. Disulfiram may enhance the sedative effects of CNS depressants. Concurrent use with theophylline may decrease theophylline clearance.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. Patients should contact their healthcare provider if they have missed several doses, as restarting therapy may require medical supervision.
Overdose
Symptoms of overdose may include nausea, vomiting, dizziness, ataxia, and in severe cases, seizures, respiratory depression, and cardiovascular collapse. In case of suspected overdose, seek immediate medical attention. Treatment is supportive and symptomatic. There is no specific antidote. Gastric lavage may be beneficial if performed soon after ingestion.
Storage
Store at room temperature (15-30°C or 59-86°F) in a tightly closed container, away from light and moisture. Keep out of reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Disulfiram is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual results may vary. Patients should consult with their healthcare provider for personalized medical advice and to discuss potential risks and benefits before starting any new medication.
Reviews
Clinical studies have demonstrated that disulfiram is effective in supporting abstinence when combined with comprehensive treatment programs. In randomized controlled trials, patients receiving supervised disulfiram administration showed significantly higher abstinence rates compared to placebo groups. Many addiction specialists report that motivated patients who understand the mechanism of action and consequences of alcohol consumption while on disulfiram often achieve sustained periods of sobriety. Patient experiences vary, with some reporting the medication provides crucial psychological reinforcement, while others find the side effects challenging. Success appears highest when disulfiram is integrated with ongoing counseling and support systems.