ALCOHOL
DETERRENT THERAPY
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.
HISTORY
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.
Disulfiram
·
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.
·
Disulfiram is a medicine used in the long term
treatment of patients with alcohol misuse.
·
lt 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
·
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.lt 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.lt should be taken before bed time to avoid drowsiness in
day time.
METABOLISM
Disulfiram
is completely absorbed from the stomach after oral administration.lt 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.
CONTRAINDICATIONS
·
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.
SIDE
EFFECTS
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%
·
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.
DISULFIRAM-
ETHANOL REACTION
·
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:
·
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
Disulfiram
ACTION
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.
DON'TS
DURING Disulfiram THERAPY
·
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, Ayurveda
Tonics, After Shave lotion, Perfumes, Spirits, Spirit based Paints, glues,
thinners, etc., and fermented foods.
·
The
Disulfiram -Alcohol Reaction may occur as long as one or two weeks after
the last dose of Disulfiram.
MYTHS RELATED
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.
HOW
DOES IT HELP
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).
DURATION
·
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 up to 2 years.
TIMINGS
·
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.
A
GOOD OUTCOME REQUISITES
·
The person is highly motivated.
·
Daily use of Disulfiram under supervision.
·
Abstinence prior to treatment.
·
Regular contact with the doctor or treating
team.
TREATMENT
FOR REACTION
·
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.
·
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 patient’s
symptoms.
NURSES
RESPONSIBILITY
·
An informed Consent should be taken before
Starting treatment.
·
Ensure that at least 12 hours 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.
·
Patients should be warned that the Disulfiram-
alcohol Reaction might continue for as long as for 2 weeks after the last dose
of Disulfiram.
NURSES RESPONSIBILITY
·
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.
COMMENTS