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Home , Disulfiram

Treatment Options for Use Disorder

Acamprosate Disulfiram

Na+ mu Pearls opiates Pearls Ca+ Pearls glu Pearls Alcohol Withdrawal Syndrome CAI Serves as “artificial alcohol”; may Can be used for patients who Disulfiram should not be given to May be useful for patients who be less effective in situations in have achieved abstinence, are a patient in a state of alcohol have achieved abstinence, are glu GABA which the patient has not yet Alcohol either acts directly upon mu trying to achieve abstinence, or intoxication or without the GABA trying to achieve abstinence, or abstained; patients should are trying to reduce heavy Alcohol is metabolized to , patient’s full knowledge; the are trying to reduce heavy Symptoms begin within a few hours of discontinuation and may is a derivative of the receptors or causes release of continue treatment even if relapse drinking; less effective in patients which in turn is metabolized by patient should not take disulfiram Like alcohol, topiramate both reduces drinking; may be useful as an last a few days to a week amino acid taurine and, like alcohol, endogenous ; in either case, the occurs but should disclose any who are not abstinent at the time . Disulfiram is for at least 12 hours after drinking; excitatory glutamate adjunct agent; side effects both reduces excitatory glutamate result is increased release new drinking; dosing schedule of treatment initiation; adherence an irreversible inhibitor of aldehyde a reaction may occur for up to 2 neurotransmission and enhances include sedation, , and neurotransmission and enhances to the nucleus accumbens. Naltrexone may affect adherence; generally is greatly increased with the dehydrogenase, thereby blocking this weeks after disulfiram is stopped; inhibitory GABA neurotransmission. It weight loss; can cause metabolic Outpatient Treatment inhibitory GABA neurotransmission. In blocks mu opioid receptors, and thus well tolerated, with diarrhea as the injectable formulation; side second-stage . When the patient should be advised not is also a carbonic anhydrase inhibitor. acidosis or kidney stones; particular, it seems to block mGlu theoretically reduces the euphoria and most common side effect; no effects include nausea, , alcohol is consumed in a patient taking to consume any food or adverse effects may be dose For patients with: receptors and perhaps also NMDA high of drinking. known interactions with and site reactions (injection); may disulfiram, toxic levels of acetaldehyde dependent Mild to moderate AWS (tremor, elevated pulse rate and blood beverages containing alcohol; the 90 90 990 90 #47 79 #4 #4 0so0098 8 and here 009 r soe ame dr #479909 #40 sod etarl n etc h so and so 0 receptors. dosp hi ress ospital name nh e dd her o a am tac o address e e 8 r s n s e 039 tc 9 d al s 4e9 c etc 0 it re et 4e9 00 sp d 9o 0c39o pressure, sweating, agitation, nervousness, sleeplessness, build up, which leads to , d t 4 3 c e # ho a 90 et 4e name addre ss etc be preferred treatment if goal is ame psychotropic (not n ess etc patient should carry an addr e am s n es dr ad Dosing and Use

0 90 9909 90 #47 anxiety, and depression) 9 , nausea, vomiting, and 7 #4 # d4 0so009r8e 98 o an e he 000 dr srenam c dr so #4799090 reduced-risk drinking; can block metabolized by hepatic ; 4 o l et and s # s phieta ss hospita o nhdose ddre l name here o a am tac o address e emergency card stating that s/he s e 39 tc 8 r l n ss 90 c 9 d ta e 4e tc et 00 pi dr o e 4e9039o 40 s d 39 c etc # ho a 90 et 4e name address e etc nam ess etc addr

me other symptoms. na s res dd Dosing and Use does not inhibit/induce hepatic a effects of opioid-containing is taking disulfiram; common side

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me na s res Dosing and Use Relief of immediate symptoms, prevention of complications, d ad complain of apathy with chronic 90 Tablets: 25 mg, 100 mg, 200 mg 0 0 dermatitis, and sedation; not Formulations: 9 99 90 #47 79 #4 #4 0so0098 8 and here 009 r soe me d #47990 #40 sod earl na etc r so and so 90 d sp hit ress hospital nam anhoe acdd add e here so am et 39o ress etc 8 r l n ss 90 c 09 d a re 4e tc et 0 pit d 9o e 4e9039o 40 s d 3 tc etc and initiation of rehabilitation # ho a 90 e 4e name address e etc treatment nam ess etc Tablets: 25 mg, 50 mg, 100 mg addr recommended for patients older Sprinkle capsule: 15 mg, 25 mg e am s n es Dosing and Use dr ad Supportive care and repletion of nutrient, fluid, or mineral Formulations: Oral solution: 12 mg/0.6 mL than age 60 or for those with deficiencies (especially vitamin B) Tablet: 333 mg Intramuscular: 380 mg/vial severe pulmonary disease, Dosage Range: Formulations: chronic renal failure, diabetes, Up to 300 mg/day; requires slow Dosage Range: Tablet: 250 mg, 500 mg Alternative options may include carbamazepine, valproate, or peripheral neuropathy, seizures, upward titration to reduce side effects Dosage Range: Oral: 50 mg/day topiramate 666 mg 3 times daily (>60 kg) Special Populations , or portal hypertension Injection: 380 mg every 4 weeks Dosage Range: 666 mg 2 times daily (<60 kg) Special Populations Approved For: Special Populations Approved For: 250–500 mg/day, one-year duration Multiple seizure disorders; migraine Safety and efficacy have not prophylaxis Inpatient Treatment Safety and efficacy have not Special Populations Approved for use in children age been established Blockade of effects of exogenously Approved For: Not approved for alcohol use disorder Approved For: been established 2 and older for treatment of administered opioids (oral only) Maintenance of alcohol For patients with: Maintenance of alcohol Pregnancy risk category C (some abstinence Safety and efficacy have not seizures; clearance is increased Severe AWS (hallucinations, , psychotic abstinence animal studies show adverse Pregnancy risk category C (some been established in pediatric patients symptoms, and seizures) effects; no controlled studies in Side Effects and Safety animal studies show adverse Side Effects and Safety Extremely high alcohol intake humans) effects; no controlled studies in Significant psychiatric symptoms Side Effects and Safety Pregnancy risk category C (some Pregnancy risk category C (some humans) Side Effects and Safety animal studies show adverse animal studies show adverse effects; no controlled studies in effects; no controlled studies in Limited available data in patients Limited available data in patients humans) humans) with cardiac impairment with cardiac impairment

Dose adjustment not generally Contraindicated in patients with Use with caution in patients with necessary for mild renal Psychosocial + Pharmacologic For moderate renal impairment, Eosinophilic pneumonia, severe cardiovascular disease cardiac impairment impairment; not studied in recommended dose is 333 mg hepatocellular injury (at excessive moderate to severe impairment Metabolic acidosis, kidney stones, three times daily; doses), severe injection site Lower dose by half for patients , congestive secondary narrow-angle closure contraindicated in severe reactions requiring surgery Not recommended for patients with renal impairment Dose adjustment not generally , respiratory glaucoma, oligohidrosis and impairment with chronic renal failure Do not use if patient: is taking necessary for mild hepatic depression, hepatotoxicity hyperthermia (more common in Suicidal ideation and behavior opioid analgesics, is currently impairment; not studied in severe Contraindicated in patients taking children), rare activation of suicidal Use with caution in patients with dependent on opioids or is in hepatic impairment; , amprenavir, ideation and behavior hepatic impairment Dose adjustment not generally acute opiate withdrawal, has Not recommended for patients contraindicated in acute hepatitis , or , and in Do not use if patient has severe necessary for patients with failed the naloxone challenge, or with hepatic insufficiency or or failure those with psychosis or No absolute contraindications renal impairment hepatic impairment has a positive urine screen for cirrhosis cardiovascular disease other than allergy to topiramate opioids Pharmacotherapy is good for:

Patients with active alcohol dependence Patients who have stopped drinking but have cravings or slips Patients who have previously failed to respond to psychosocial Motivational Enhancement Therapy Cognitive Behavioral Therapy 12-Step Facilitation and 12-Step Fellowships approaches

Psychotherapeutic or psychosocial approaches can: Motivational interviewing is patient-focused Twelve-Step Facilitation (TSF) consists of a structured, counseling with the direct goal of enhancing one’s manual-driven approach to facilitating early recovery from Increase motivation for abstinence motivation to change by helping explore and / and other drug abuse/. Improve motivation for adherence resolve ambivalence (e.g., “I want to stop drinking, Its purpose is to help patients accept their need to abstain Cognitive behavioral therapy (CBT) is based on the Improve overall outcomes but I’m afraid I’ll be awkward in social situations”). premise that our behaviors stem from our thoughts and to actively participate in 12-step fellowships (such as 250 Although it was originally developed to help Joe’s Bar and beliefs, and therefore that negative thoughts , or AA) as a means of maintaining 250 individuals with problem drinking, it can be used in can lead to maladaptive behavior. CBT is abstinence. It is intended to be implemented on an the treatment of patients with other forms of designed to modify the behaviors and individual basis in 12 to 15 sessions and is based in the 12 and dependence. With thoughts/beliefs that contribute to substance abuse steps and traditions of AA. motivational interviewing the clinician is a facilitator, and dependence. CBT helps patients identify helping the patient identify, articulate, and resolve triggers for substance use, such as particular Although mutual support groups such as 12-step his or her own ambivalence without direct people or places or even emotions, and helps them fellowships can be very beneficial in helping patients with persuasion, confrontation, or coercion. develop techniques to avoid those triggers or, if substance use disorder, these programs are based on the unavoidable, to cope with them. premise that addiction is an illness in which those afflicted Motivational enhancement therapy (MET) is an are unable to control their use of the drug. As such, they adaptation of motivational interviewing in which the typically require complete abstinence as the goal. This may therapist uses feedback to strengthen the patient’s therefore pose conflict for patients with alcohol use own motivation and commitment to change. disorder who are attempting reduced-risk drinking.

Presented at the 2011 NEI Global Psychopharmacology Congress.