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.

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.