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- disulfiram blocks the oxidation of alcohol causing an accumulation of acetaldehyde
after drinking - disulfiram is an inhibitor of hepatic aldehyde dehydrogenase
(ALDH). This results in symptoms such as abdominal colic, flushing, anxiety,
dizziness, tachycardia, vomiting and headache. Symptoms start 5-15 minutes
after drinking alcohol and last for several hours. Note that the intensity
of the reaction is dependent on the individual, the disulfiram dose and the
alcohol intake (1)
- if large doses of alcohol are consumed whilst receiving disulfiram treatment, collapse, cardiac arrhythmias and even death can occur
- disulfiram has been given to break the drinking habit in alcoholics and it may deter relapse in abstinent patients
- before prescribing disulfiram, patients should be warned that the severity of the reaction is unpredictable. Occasionally a reaction may be triggered by the small amount of alcohol in preparations such as cough linctuses
- hepatoxicity and psychotic reactions are rare adverse effects to disulfiram
treatment
- elevated liver function tests - hepatotoxicity is a rare adverse effect
to disulfiram treatment; liver function tests should be checked before
commencement of and at regular intervals throughout treatment - disulfiram
treatment should be witheld if liver enzymes are elevated ten or more
times than normal (2)
- disulfiram is contraindicated during pregnancy and in patients with a psychosis;
also contraindicated if there is an established hypersensitivity
- disulfiram should be used with caution in patients with diabetes, epilepsy
and hypercholesterolaemia (1)
- disulfiram is also contraindicated in patients with seriously impaired
cardiac, respiratory, hepatic or cerebral function.
The summary of product characteristics must be consulted before prescribing
this drug.
Reference:
- Prescriber 2004; 15(9): 16-25.
- Drug and Therapeutics Bulletin (2000); 38 (8):60-64.
- Drug and Therapeutics Bulletin (1996), Drugs and alcohol: harmful cocktails?;
34 (5): 36-8.
- Kwentus J, Major LF (1979), Disulfiram in the treatment of alcoholism,
J Stud Alcohol, 40, 428-46.
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