WHEN TO START DISULFIRAM THERAPY?

Disulfiram should be started after detoxification from alcohol is completed and the patient is free of alcohol or alcohol-containing beverages for at least 12 hours before the start of disulfiram

Baseline investigations.

• Haemogram
• Liver function test: Attention should be paid to the liver enzymes (AST and ALT levels); Disulfiram should not be started if the AST and ALT levels are raised by more than 2-3 times above normal.

Beverages to be avoided with disulfiram therapy.

It should be advised that certain beverages should be avoided with disulfiram. These include: alcohol in any form (i.e. beer, wine, Indian made foreign liquor and locally brewed liquor), vinegars, sauces, cough mixtures,vitamin tonics and elixirs that contain alcohol, and even mouthwashes which may contain alcohol

  

What is the dose of disulfiram in starting ?

Disulfiram should be started as a single tablet containing 250 mg, once a day. It may take at least 4 - 5 days to reach a steady state level. The timing of the dose should be fixed, such that the patient takes the tablet at a particular time of the day. Some patients may experience sedation with morning use; in such cases the dose may be shifted to night time.

Supervised disulfiram ethanol reaction (DER).

In certain cases, supervised DER may be carried out in those patients who are willing for it, and who are sceptical of the effect of disulfiram in causing a DER. This should be carried out in specialized De-addiction Centres only.

Supervision of disulfiram therapy.

Disulfiram works best where a supervisor is involved in the administration of the medication. The supervisor may be a family member/ friend/ colleague with whom the patient is in daily contact. The supervisor should be chosen with the patients' consent. The supervisor should also be informed about the treatment and its implications. He/ she should ensure that the patient takes the medication and in front of him/ her.

Disulfiram identification card.

In the end, a disulfiram identification card should be made available to the patient, stating that he/ she is taking disulfiram, and also contains in brief, the beverages to be avoided with alcohol, the signs and symptoms of disulfiram alcohol reaction, and its treatment.

What are the points to remember during initiation of disulfiram ?

• Disulfiram therapy should be carried out after detoxification from alcohol
• Disulfiram to be started at least 12 hours after last alcohol use
• Disulfiram counselling should be carried out before the start of therapy
• Written consent should be obtained before the start of therapy
• A candidate may be chosen to supervise disulfiram therapy
• Disulfiram should be started at a dose of 250 mg