Disulfiramum

Disulfiramum – the drug used at treatment of alcoholism.

Form of release and structure

Disulfiramum is released in the form of tablets for implantation (on 10 pieces in glass bottles, on 1 bottle in a cardboard pack).

Is a part of 1 tablet:

• Active agent: Disulfiramum – 100 mg;
• Auxiliary components: Mannitolum, sodium chloride, polyethyleneglycol 6000.

Indications to use

Disulfiramum is appointed at treatment of alcohol addiction for the cooperating and elected patients as supportive application.

Contraindications

• Alcohol intoxication, the use of drinks with the content of alcohol in 12 hours prior to holding a procedure;
• Mental disturbances, psychoses (without the postponed earlier acute alcoholic psychoses), attempts of suicide in the anamnesis;
• The established arterial hypertension, coronary heart disease, heart failure, earlier postponed insufficiency of peripheric circulation;
• Lactation period;
• Hypersensitivity to drug components, and also to thiocarboaminates.

It is not necessary to appoint Disulfiramum without the conscious consent of the patient.

Use of drug in the first trimester of pregnancy is not recommended. At purpose of Disulfiramum pregnant women need to correlate advantage of therapy to possible risk. At the same time it is necessary to consider the available data on developing of inborn malformations at babies whose mothers used drug in combination with other medicines.

Route of administration and dosage

Tablets for implantation have to be sterile, without impurity and damages, to be stored in original packaging.

Implantation is carried out after careful disinfection and a local anesthesia, doing a small cut (about 6 mm) in the left ileal area. The place of a section has to be located rather low not to allow friction by a belt. Hypodermic cellulose is moved apart and by means of a trocar subcutaneously (podfastsialno) enter 2 tablets of Disulfiramum (on 100 mg) on depth of 4 cm. It is necessary to repeat the procedure 4 times, placing tablets around the place of a cut zvezdoobrazno, parallel to the surface of skin.

The general dose – 8-10 tablets (800-1000 mg). On a cut the stitch with the subsequent sterile bandage is put. It is possible to repeat the procedure 8-9 months later.

If tablets were implanted too close to the place of a section, emergence of a phenomenon of rejection is possible. Because of friction of the place of implantation by a belt or premature removal of seams suppuration can develop.

Side effects

Disulfiramum can lead to development of such side effects (caused by properties of active agent) as: drowsiness, vomiting, nausea, taste of garlic or metal smack in a mouth, an unpleasant smell at patients with kolostomy, injury of hepatocytes, exceptional cases of hepatitis (similar disturbances are sometimes observed at the patients with nickel eczema who do not have alcoholism), an optic neuritis, a polyneuritis of the lower extremities, confusion of consciousness, memory loss, an adynamy, the passing impotence, a headache, allergic dermatitis, fatigue. In rare instances development of psychotic reactions, including schizophrenia, a mania, paranoid and depressions can be noted.

Because of a combination Disulfiramum - alcohol there can be following disturbances: respiratory insufficiency, a cardiovascular collapse, disturbances of a heart rhythm, stenocardia, sometimes – a myocardial infarction, and also neurologic frustration, consciousness oppression, up to a coma, wet brain. At alcohol intake in number of more than 50-80 ml of 40% of ethanol development of heavy disturbances of respiratory and cardiovascular systems, hypostases, spasms is possible. In these cases it is necessary to carry out disintoxication and symptomatic therapy with the accompanying introduction of analeptics.

Special instructions

Before implantation it is necessary to conduct a course of a gradual excommunication of the patient from alcohol.

At therapy of Disulfiramum it is strictly forbidden to take alcoholic beverages as it can lead to development of life-threatening symptoms. In this regard drug can be used only with the consent of the patient and provided that he is informed on the existing dangers connected with alcohol intake at use of Disulfiramum. It is possible to appoint drug after very detailed anamnesis and assessment of all shortcomings and advantages of such treatment of alcoholism.

Signs of intolerance of alcohol can also develop after use of liquids with the content of alcohol (for example, the cough syrups, sauces, liquids for rinsing of a mouth, vinegar warming means, aftershave lotions and other alcohol-containing cosmetics).

Disulfiramum should be applied with care the patient with a liver or renal failure, diseases of cardiovascular or respiratory systems, epilepsy, a diabetes mellitus. Disulfiramovy reaction can lead to deepening of these diseases.

The polyneuropathy which can develop in therapy time passes at purpose of vitamins of group B or removal of the implanted tablets. In the place of implantation the small hillock which is caused by fibrosis of a hypodermic and fatty tissue of skin can be formed. At co-administration with peroral anticoagulants it is necessary to exercise more frequent control of maintenance of a prothrombin in blood and correction of doses of anticoagulants that is connected with high probability of developing of bleeding.

Medicinal interaction

At simultaneous use of Disulfiramum with some medicines there can be following effects:

• Antitrombotichesky drugs, antipyrine, Phenytoinum, chlordiazepoxide and diazepam: strengthening of their action;
• Peptidin, morphine, amphetamine: strengthening of their action (data are obtained when carrying out experiments on animals);
• Amitriptyline, Chlorpromazinum: strengthening of symptoms of disulfiramovy reaction;
• Diazepam: weakening of symptoms of disulfiramovy reaction;
• Rifampicin: braking of oxidation reaction and allocation by his kidneys;
• Isoniazid: influence on functioning of the central nervous system, development of dizziness, lacks of coordination of movements, irritability, sleeplessness;
• Metronidazole: development of a disorientation and psychotic states (combined use is not recommended);
• Organic solvents with the content of alcohol, acetic aldehyde or paraldehyde: development of disulfiramovy reaction;
• Alfentanil: increase in time of its action.

Terms and storage conditions

To store in protected from light, the place, dry, unavailable to children, at a temperature up to 25 °C.

Period of validity – 4 years.