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January 13, 2020

Disulfiram is a type of aldehyde dehydrogenase inhibitor used in the treatment of alcoholism. It is primarily prescribed to recovering alcoholics, so they can refrain from drinking alcohol. It is the first medicine approved by the U.S Food and Drug Administration since 1951 for the treatment of alcohol abuse and alcohol dependence.

Disulfiram is an effective preventive medication because it causes a very unpleasant reaction once you drink even a small amount of alcohol. It produces an acute sensitivity to ethanol causing an effect of a hangover which can be felt as soon alcohol is consumed.

This medication works by interfering with the way your body uses alcohol. Once consumed, the alcohol is broken down in the body into a compound known as acetaldehyde. It is then further broken down into aldehyde dehydrogenase by your liver. Disulfiram prevents this enzyme from working. When you consume alcohol, your body won’t be able to oxidize the alcohol normally causing a build-up of acetaldehyde in your bloodstream that is 5 to 10 times greater than what would normally be present after drinking alcohol. The high level of acetaldehydes acts directly in your blood vessels and heart which causes a drop in your blood pressure, flushing and other potentially dangerous reactions. This reaction is known as Disulfiram reaction, enough to deter you from having another drink.

When and How to Use Disulfiram

Use Disulfiram exactly as directed by your doctor or by a health care professional. Disulfiram comes in a tablet to take by mouth. It is typically taken once a day. The initial dose is 500 mg a day for 1 to 2 weeks. After 2 weeks, your doctor will give you a maintenance dose for 125 to 500 mg a day. The average maintenance dose is 250 mg a day for months or even years. Treatment with Disulfiram continues until patients develop self-control.

You can take Disulfiram with or without food. Take the tablet with a glass of water. For a missed dose, at least more than 12 hours late, just leave out the dose and take the next dose when it is due. Do not take two doses to make up for the missed one.

What to know before taking Disulfiram

  • Only people who want to try to quit drinking alcohol and are aware of the consequences of the side effects should use Disulfiram.
  • Disulfiram can cause a severe, potential and unpleasant dangerous reaction when you drink alcohol. The knowledge of this fact can help you stop drinking alcohol.
  • Due to possible severe reactions, do not give Disulfiram to those who are psychosis, have severe heart disease and those who are allergic to any of its ingredients.
  • Pregnant women must not also take this medicine as it can interact with other medications.
  • Do not give this to anyone without consent or knowledge of its severe reactions.
  • Disulfiram does not reduce your cravings for alcohol nor will it treat withdrawal symptoms of alcohol. It will only serve as a psychological and physical deterrent if you want to stop drinking.
  • Disulfiram may interact with certain foods, liquid medications that contain sufficient alcohol. Always check the ingredients and avoid those that contain alcohol. In case you get some symptoms of Disulfiram reaction either from exposure to a certain amount of alcohol or from drinking, contact your doctor as soon as possible.
  • This medicine can cause drowsiness during the beginning of your treatment. Avoid doing activities that require mental alertness like operating machinery and driving.
  • Use this with care among patients with:
    • Diabetes
    • Epilepsy
    • Liver disease
    • Kidney failure
    • Diseases that affect the airways or lungs
  • Do not use among patients with:
    • Heart failure
    • High blood pressure
    • Coronary heart disease
    • Pregnant or breastfeeding women
    • A hereditary blood disorder called acute porphyrias
    • People with mental disorder or severe personality disorders
    • Who has had a stroke
    • Who are at risk of suicide
    • Who are allergic to any of its ingredients

Possible Side Effects of Disulfiram

Disulfiram can cause unpleasant effects when you consume even the slightest amount of alcohol. However, the severity of the reaction can range from mild to severe, depending on how much Disulfiram and how much alcohol you have consumed. These effects include:

  • Nausea and vomiting
  • Flushing of the face
  • Breathing difficulty
  • Weakness
  • Chest pain
  • Mental confusion
  • Choking
  • Throbbing headache
  • Anxiety
  • Blurred vision
  • Sweating
  • Low blood pressure
  • Fainting

In severe reactions, there may be a cardiovascular collapse, respiratory depression, heart attack, convulsion, acute congestive heart failure, abnormal heart rhythms and death. These effects can last for up to 1 hour or more and may begin about 10 minutes after you consume alcohol.

Other known side effects include:

  • Decreased sex drive
  • Bad breathe
  • Fatigue and drowsiness
  • Inflammation of the optic nerve
  • Liver problems
  • Mood changes, mania, depression, strange or abnormal thoughts
  • Peripheral nerves inflammation with symptoms such as numbness or pins and needle sensation

Getting the Best Result from Disulfiram

  • Do not take Disulfiram at least 12-24 hours after drinking. A reaction may occur for up to 2 weeks after this drug has been stopped. Once you stopped your medication, do not drink alcohol for two weeks as the reaction may still occur at this time.
  • Use this medication in combination with other forms of therapy including counseling, behavior modification, and psychotherapy.
  • If you are using this medicine, it is best to avoid sauces and beverages containing alcohol. Do not drink any medications that contain alcohol such as cough syrup.
  • Its effectiveness depends on how you use it. Since it is a daily pill, you cannot just simply stop taking this medicine and start drinking a few days later.
  • The long-term use of Disulfiram is proven to be effective with an abstinent rate of 50%. The longer you use it the more it becomes effective because you develop a habit of not drinking.

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