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Disulfiram

Disulfiram is a different sort of drug to the others in this category. It is a drug discovered in the 1920s and used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. Trade names for disulfiram in different countries are Antabuse and Antabus.

Most common Antabuse side effects [eHealthme]

• Fatigue - (57 reports)
• Nausea - (53 reports)
• Weakness - (52 reports)
• Stress and anxiety - (40 reports)
• Memory loss - (39 reports)
• Suicidal ideation - (36 reports)
• Nausea and vomiting - (32 reports)
• Dizziness - (31 reports)
• Confusional state - (31 reports)
• Malaise - (30 reports)

Disulfiram is also being studied as a treatment for cocaine dependence, as it prevents the breakdown of dopamine (a neurotransmitter whose release is stimulated by cocaine); the excess dopamine results in increased anxiety, higher blood pressure, restlessness and other unpleasant symptoms.

Under normal metabolism, alcohol is broken down in the liver by the enzyme alcohol dehydrogenase to acetaldehyde, which is then converted by the enzyme acetaldehyde dehydrogenase to the harmless acetic acid.

Disulfiram blocks this reaction at the intermediate stage by blocking the enzyme acetaldehyde dehydrogenase. After alcohol intake under the influence of disulfiram, the concentration of acetaldehyde in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone. As acetaldehyde is one of the major causes of the symptoms of a "hangover" this produces immediate and severe negative reaction to alcohol intake.

Some 5–10 minutes after alcohol intake, the patient may experience the effects of a severe hangover for a period of 30 minutes up to several hours. Symptoms include “flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache, visual disturbance, mental confusion, postural syncope, and circulatory collapse [sic]”.

There is no tolerance to disulfiram: the longer it is taken, the stronger its effects. As disulfiram is absorbed slowly through the digestive tract and eliminated slowly by the body the effects may last for up to two weeks after the initial intake; consequently, “medical ethics dictate that patients must be fully informed about the disulfiram-alcohol reaction”

A nine-year study published in 2006 found that incorporation of supervised disulfiram and a related compound calcium carbimide into a comprehensive treatment program resulted in an abstinence rate of only 50%. Disulfiram does not reduce alcohol cravings, and therefore a major problem associated with this drug is “extremely poor compliance”.

A study by Fuller et al (1986) that followed chronic alcoholics for a period of 1 year found no statistically significant differences in abstinence rates between the group that received 250 mg/day of disulfiram and the group that only received counseling. The reason for this finding was that only 20% of subjects in disulfiram group were estimated to be in good compliance with the drug regimen. "Methods to improve compliance include subdermal implants, which release the drug continuously over a period of up to 12 weeks, and supervised administration practices, for example, having the drug regularly administered by one's spouse [sic]."

Most common Disulfiram side effects [eHealthme]

• Confusional state - (39 reports)
• Fatigue - (33 reports)
• Nausea - (30 reports)
• Psychotic disorder - (27 reports)
• Agitation - (26 reports)
• Hypotension - (26 reports)
• Confusion - (25 reports)
• Memory loss - (24 reports)
• Delirium - (24 reports)
• Completed suicide - (24 reports)