Disulfiram

Treatment of Chronic Alcoholism

• Indication: Disulfiram is FDA-approved to help individuals with chronic alcoholism abstain from drinking alcohol by causing unpleasant reactions when alcohol is consumed.
• Dosing:
• Initial Dose: 500 mg once daily for 1-2 weeks.
• Maintenance Dose: After the initial period, the dose is typically reduced to 250 mg once daily, based on patient response and tolerance.
• Duration: Treatment can last several months or longer, depending on the individual's needs. The goal is to help maintain sobriety as part of a comprehensive treatment plan, including counseling and support.

Cocaine Addiction

• Off-label Use: Disulfiram has been studied as a potential treatment for cocaine dependence. It may work by interfering with enzymes involved in dopamine metabolism, reducing the reward from cocaine use.
• Dosing: Similar to the dosing for alcohol dependence, typically 250 mg to 500 mg is taken once daily.

Lyme Disease (Persistent Symptoms)

• Off-label Use: Disulfiram has been investigated for treating persistent Lyme disease symptoms in some patients, though more research is needed to confirm its effectiveness.
• Dosing: The dose varies depending on the patient, but it generally ranges from 62.5 mg to 500 mg per day, depending on tolerance and physician guidance.

Prostate Cancer

• Off-label Use: There has been some research suggesting Disulfiram may have a role in treating prostate cancer due to its ability to inhibit cancer cell growth.
• Dosing: The specific dosing for this off-label use is not well-established and would be determined based on ongoing clinical trials and patient response.

Fungal Infections

• Off-label Use: Disulfiram has shown potential in treating certain fungal infections, such as onychomycosis (fungal nail infections), though it is not a standard treatment.
• Dosing: The dosage is typically 250 mg to 500 mg daily, based on the severity of the infection and patient tolerance.

• People who have severe heart diseases.
• If you have psychosis.
• Are pregnant or planning to become pregnant.
• People who have consumed alcohol within the past 12 hours.

• There is a risk of severe alcohol reactions even up to 14 days after discontinuation of Disulfiram.
• Disclose to all healthcare providers that you are on Disulfiram to avoid any medication that might contain alcohol.
• Regular liver function tests are recommended while on this medication.
• If you experience symptoms like extreme tiredness, loss of appetite, or weakness, immediately seek medical help.
• Be observant of mood changes, especially suicidal thoughts, and seek immediate help if any such symptoms occur.

Drowsiness: Feeling tired or sleepy is a common side effect.

Headache: Mild to moderate headaches can occur.

Metallic or garlic-like taste: Some people experience a strange taste.

Skin rash: A mild rash or itching may develop.

Upset stomach: Nausea or mild gastrointestinal discomfort can occur, especially when starting the medication.

Acne: Some individuals may notice breakouts or worsening acne.

Mild liver function changes: Small increases in liver enzymes may be observed in blood tests.

Liver damage: Signs include yellowing of the skin or eyes (jaundice), dark urine, severe abdominal pain, or persistent nausea. This is a serious condition requiring immediate medical attention.

Severe allergic reactions: Symptoms like swelling of the face, lips, tongue, or throat, difficulty breathing, or severe rash could indicate an allergic reaction.

Psychiatric symptoms: Hallucinations, confusion, or mood changes (such as depression or anxiety) can occur, especially if the patient has a history of mental health issues.

Severe nerve problems (neuropathy): Symptoms include tingling, numbness, pain in the hands and feet, and difficulty walking.

Vision problems: Blurred vision, double vision, or other eyesight changes may occur.

Heart problems: Irregular heartbeat, chest pain, or severe dizziness may indicate a heart-related issue.

Severe vomiting or breathing difficulties when alcohol is consumed: Drinking alcohol while taking Disulfiram can cause a serious reaction, including severe vomiting, chest pain, difficulty breathing, or even fainting.

• Consuming alcohol while under this medication can lead to critical cardiovascular issues.
• Regular blood tests are necessary to monitor liver health.
• Suicidal tendencies may increase, especially in the early period of recovery

• Metronidazole
• Paraldehyde
• Phenytoin
• Isoniazid

Naltrexone (Revia, Vivitrol):

• How it works: Naltrexone reduces the craving for alcohol and blocks the "reward" effects of drinking. It can help individuals reduce or stop drinking.

Acamprosate (Campral):

• How it works: Acamprosate helps to restore the balance of certain chemicals in the brain that are disrupted by alcohol use, reducing cravings and the risk of relapse.

Topiramate (Topamax):

• How it works: Topiramate is an anticonvulsant that has been shown to reduce alcohol cravings by affecting brain chemicals that play a role in addiction.

Gabapentin (Neurontin):

• How it works: Gabapentin is an anticonvulsant that has been used off-label to reduce alcohol cravings and withdrawal symptoms, helping people stay sober.

Baclofen:

• How it works: Baclofen is a muscle relaxant that has shown promise in reducing alcohol cravings and helping to prevent relapse in some patients. It is used off-label for alcohol dependence.

Behavioral Therapy and Counseling:

• How it works: In addition to medications, behavioral therapy (such as Cognitive Behavioral Therapy or Motivational Interviewing) is an essential component of alcohol dependence treatment. Therapy can help patients understand triggers, develop coping strategies, and maintain sobriety.