Addiction-Rx: Recent Episodes
Centre for Addiction Medicine & NIMHANS Digital Academy
Disulfiram is the first drug that was approved for alcohol use disorder by the FDA in 1948 .
Disulfiram is a white odorless and tasteless powder and is soluble in water and alcohol. This is the reason many times surreptitiously family members give it but usually end up causing more harm than good.
Mechanism of action of disulfiram-It irreversibly inhibits acetaldehyde dehydrogenase enzyme which is required for conversion of acetaldehyde to the acetate.
Acetaldehyde get accumulated into the body and is responsible for an unpleasant reaction and this is called as the disulfiram ethanol reaction (DER)
Re-establishment for the enzyme needs a time of two weeks and hence DER may occur even in the initial days of stopping disulfiram.
Disulfiram is actually an aversive agent and not an anti-craving agent per se.
Fear of DER is responsible for extinguishing the unwanted behavior - that is the alcohol consumption and not the pharmacological action per se.
Why do some get addicted and why others do not. Let us listen to Prof Vivek Benegal, Professor, Centre for Addiction Medicine, NIMAHNS
Choosing anti-craving in patients with alcoholic liver disease
In this episode, the discussion is focused on long-term pharmacological management of AUD in ALD. Here, we discuss all the available options for management of AUD and tease out as to which one would suit for patients for ALD discussing their metabolism
Physicians are likely to encounter alcohol withdrawal syndrome in their patients with Alcohol Use Disorders. Most patients with early stage of liver disease are likely to manifest milder withdrawal symptoms. But patients with significant liver disease are likely to present with moderate to severe withdrawal symptoms. The AWS can range from insomnia, tremor, autonomic hyperactivity to more severe seizures and delirium tremens. The symptoms usually start from 6 to 8 hrs of last drink and pick in 24-72 hours. Oxazepam and Lorazepam are preferable for AWS patients with ALD. For patient with severe ALD like cirrhosis or encephalopathy, benzodiazepine should be used cautiously and only if needed in an in-patient setting. There is a possibility of using non-benzodiazepine agents i.e., baclofen, gabapentin, especially patients with moderate to severe ALD. Supportive care should include fluid and electrolyte balance, treatment of concurrent infections, Thiamine supplementation. Thiamine supplementation is critical to prevent the development of Wernicke's encephalopathy. The clinician should also utilize this to engage the patients in treatment and work on building up the patient's motivation for long-term abstinence.