Pharmacotherapy used for alcohol and cocaine use disorders in a CAPS-AD of Minas Gerais

Abstract Substance use disorder is one of the major social and public health problems in the world. The present study analyzed the pharmacoepidemiological profile of patients treated at the Psychosocial Treatment Center for Alcohol and Substance Use Disorders (CAPS-AD) for treatment of alcohol use disorders (AUD), cocaine use disorders (CUD) and concomitant alcohol and cocaine use disorders (A-CUD) in the city of Betim-MG. The study used quantitative and descriptive data and was based on the evaluation of medical records of patients attended from January to December 2016. After analyzing 295 medical records, the majority of study participants were male (83.7 %) with an average age of 46.26 for AUD, 28.88 for CUD and 34.29 for A-CUD. The most prescribed drugs for AUD were diazepam (54.1 %), thiamine (37 %), complex B vitamins (29.5 %), and disulfiram (2.7 %); for CUD, diazepam (26.9 %) and haloperidol (23.1 %). It should be noticed that although contraindicated by the guidelines, chlorpromazine (42.3 %, 25.3 %, 20.3 %) was prescribed for CUD, AUD, and A-CUD respectively. Knowing the pharmacoepidemiological profile of CAPS-AD patients is extremely important for making decisions regarding which medicines to make available to the population.

Surreptitious use of disulfiram.

Disulfiram is one of the most important drugs used in the management of alcohol use disorders . It is of significance as a treatment modality especially in low and middle income countries like India, as it is a cheaper pharmacological option compared to other medications like naltrexone and acamprosate.

Actualización del tratamiento farmacológico de la dependencia alcohólica / Pharmacological review of alcoholic dependence treatment

El objetivo de la presente actualización farmacológica es abordar la problemática de la dependencia alcohólica. Partiendo de las bases biológicas y del impacto del etanol sobre los sistemas neurobiológicos y de neurotransmisión, se hará una revisión de las principales herramientas farmacológicas para el tratamiento de la dependencia alcohólica. El disulfiram, la naltrexona y el acamprosato, todas ellas con aprobación por la FDA (Food and Drug Administration) han mostrado mecanismos de acción, perfiles de eficacia, tolerabilidad y adherencia dispares. También nos referiremos al topiramato, el que está siendo estudiado actualmente con relación a esta indicación.

The aim of the present pharmacological update is to revise the problem of alcohol dependence. Starting from the biological bases and the impact of alcohol on the neurobiological and neurotransmission systems, a revision of the main pharmacological tools for alcohol dependence treatment will be done. Disulfiram, naltrexone, acamprosate, all of them approved by the FDA (Food and Drug Administration), have shown mechanisms of action, efficacy, tolerance and adherence dissimilar. We will also refer to topiramate, which is being studied for this indication.

Disulfiram and low nickel diet in the management of hand eczema: a clinical study.

BACKGROUND: Hand eczema due to nickel sensitivity is a challenging task for the dermatologist. The average human diet provides sufficient amount of nickel, which acts as a provocating factor in nickel-sensitive individuals. When such patients are treated with steroid or other immunosuppressives, only short-term remission is obtained. This is because unless the dietary intake of nickel is minimized and the existing amount of nickel in the body of the sensitized individual is depleted, long-term remission is unlikely. AIM: To evaluate the efficacy of oral disulfiram, a nickel-chelating agent and low nickel diet (LND) in reducing the clinical symptoms and preventing frequent relapse of hand eczema in nickel-sensitive individuals. METHODS: A total of 21 patients with chronic vesicular hand eczema with nickel sensitivity were taken for this study. Patients were randomly divided into two groups: (a) Study group consisting of 11 patients (8 females and 3 males). They were prescribed disulfiram orally for a period of 4 weeks; they started LND 2 weeks prior to initiation of disulfiram therapy and continued till the end of follow-up period. (b) Control (placebo) group consisting of 10 patients (7 females and 3 males). They were allowed to continue with normal diet. Each of them received lactose tablet daily as placebo for 4 weeks. It was a comparative study and participants were not aware if they belonged to study group or control group (single blind trial). RESULTS: Hand eczema healed completely in 10 (90.9%) out of 11 patients treated with disulfiram and LND during the treatment period in the study group, compared with 1 out 10 patients in control (placebo) group (non significant). Mild relapse was noted in 5 patients in between 2-12 weeks of follow-up period. CONCLUSION: Low nickel diet and short course of oral disulfiram therapy can be considered a good option for the control of chronic hand eczema in nickel-sensitive individuals.

Psychosis during disulfiram therapy for alcoholism.

Fifty-two patients (51 males, one female) of alcohol dependence/abuse diagnosed according to DSM 111 R1 were registered for disulfiram treatment and were admitted for a 4-week period. No alcohol challenge test was given during their hospital stay. Disulfiram tablets were administered 250 mg twice daily after food. After one week's hospital stay with disulfiram therapy they were sent home to be followed up initially after 15 days and later on once a month. Six male patients developed psychotic symptoms. All of them had shown a mood disorder but no thought disorder was observed. Psychotic symptoms remitted completely after withdrawing disulfiram and then a short course of antipsychotic therapy was given, except in one patient who had to be given lithium for remission of symptoms.

Efecto antabuse e intoxicación con disulfiram: presentación de dos casos clínicos / Pharmacological and toxic effects of firam: report of 2 clinical cases

Se prepara un estudio analítico sobre los efectos farmacológicos y toxicológicos del Disulfuro de Tetraetiltiuram (Disulfiram), el cual es utilizado en la terapéutica del alcoholismo crónico, por su efecto antabuse, uso que se remonta a más de 30 años. Posteriormente, se presentan dos casos de pacientes intoxicadas con disulfiram, y las ingresaron en el Servicio de Emergencia de Adultos del HUC; en un lapso de tiempo de 10 meses. De dos casos, uno tuvo un desenlace fatal

Estudio clínico de disulfiram en suspensión inyectable: una nueva alternativa en el tratamiento del alcoholismo / Clinical study of disulfiram in intravenous suspension. A therapeutic alternative for alcoholism

A disulfiram suspension (propylenglycol and water) was used to treat 45 alcoholic patients. Inactive suspension was given to 8 control alcoholic patients. Pain, local inflammation, thirst and drowsiness were related to disulfiram suspension, but not to solvent administration. Patients receiving disulfiram who drank alcohol experimented the known reaction which was related to subsequent abstinence from alcohol. 67% of patients receiving disulfiram remained abstinent after 1 year of follow up

Medicamentos ectoparasiticidas: risco e benefício / Ectoparasiticides drugs: risk and benefit

A escolha de produtos ectoparasiticidas para uso humano deve obedecer certos critérios, principalmente envolvendo a relaçäo risco-benefício, desde que muitos säo substâncias capazes de destruir formas de vida. As relaçöes adversas, os efeitos colaterais, a toxicidade, aliados a fatores como formulaçöes, interaçäo medicamentosa, incompatibilidades, freqüência das aplicaçöes e outras vias de penetraçäo orgânica devem ser avaliados. O trabalho se propöe a atualizar e revisar os dados farmacológicos e toxicológicos dos ectoparasiticidas mais freqüentemente utilizados para adequar a sua escolha

El síndrome acetaldehído en el tratamiento con disulfiram / The acetaldehyde syndrome in the treatment with disulfiram

El estudio de 30 pacientes con dependencia alcohólica primaria tratados con disulfiram durante su hospitalización en un servicio de deshabituación, fue orientado a explorar las manifestaciones objetivas y subjetivas producidas durante las cinco pruebas alcohol-disulfiram, programadas en cada integrante de la muestra, efectuándose controles sistemáticos a los 10, 20, 30 y 60 minutos de ingerido el etanol. Los autores describen la frecuencia de los síntomas y signos recogidos y evidencian una relación directa entre la cantidad de alcohol ingerido en la prueba y la precocidad en la instalación, intensidad y duración de las manifestaciones del síndrome acetaldehídico

Estudo clínico controlado duplo-cego paralelo com dissulfiram suspensäo versus placebo em pacientes escabióticos: avaliaçäo de efeitos colaterais após ingestäo de álcool / Parallel double-blind controlled clinical trial with dissulfiram suspension versus placebo in scabiotic patients: evaluation of side-effects after alcohol ingestion

Foram avaliados em 24 pacientes escabióticos os eventuais efeitos colaterais surgidos após aplicaçäo tópica de dissulfiram (dissulfeto de tetraetiltiouram) suspensäo seguida de ingestäo de dose padronizada de álcool. Os autores observaram que os efeitos colaterais foram mínimos, sendo maiores no grupo que utilizou placebo, o que permite concluir ser o álcool, por si só, o responsável pelos efeitos colaterais obtidos