Disulfiram: How It Is Used In Alcoholism Treatment
David Richards
For almost half a century, disulfiram, or TETD, has been a staple for alcoholics trying to quit. It is estimated that around 200,000 people use the medication regularly to help them stay sober. In this article, we will take a look at disulfiram and alcoholism treatment.
The History Of TETD
TETD was originally a chemical used in the manufacture of rubber in the early 1900's. In 1937, it was discovered that workers who were too closely exposed to TETD developed a reaction if they drank. If one of these workers consumed alcohol, his face would turn red and he would suffer from hypotension and tachycardia. This was noticed by a doctor, and he suggested that TETD might be effective for getting people to stop drinking. However, nobody listened to him.
Experiments with TETD continued. In the 1940's, two scientists who were experimenting with using it to see what effect it had on the respiratory system of lower life forms made some discoveries. In the scientific spirit, the men took a dose of TETD themselves to see what would happen. What did happen was that they couldn't go near a drop of alcohol without getting sick. Through this, it was discovered that TETD has an effect on how we metabolize alcohol, and in a short time, doctors were prescribing it to alcoholic patients.
In the early 1960's, TETD fell out of favor. This was because, since its discovery, doctors had been prescribing doses that were too high, and their patients were having severe reactions. Sensibly enough, they figured they needed a high dose in order for it to interact with the alcohol. In the 1950's, a typical daily dose might be as much as 3,000 mg. While it worked in keeping them off the bottle, it caused some nasty side effects. More experiments were carried out and, since the 1960's, the usual does has been something like 500 mg a day. The dosage depends on several factors, including how severe an alcoholic the patient is. Physicians have refined their techniques for prescribing TETD since the advent of its use.
The Clinical Use Of TETD
The first step to treat an alcoholic is for him to stop drinking. After that, he must be detoxified, followed by a period of being sober. This period is necessary to restore his brain chemistry to normal. TETD is most effective early on, helping the patient to simply not drink. In addition, it may be good to keep taking TETD for the next year as a safeguard against relapsing. A friend or family member can help to make sure the patient is taking the medication regularly.
Like alkaseltzer, TETD is dissolved in water. After drinking it down, another glass of regular water should drunk next. It is best for the patient to take the first one in the doctor's office, under the doctor's supervision, more than 12 hours since the last drink. This is an important point. It helps to do it in the office so that the patient isn't tempted to have one last one for the road.
Just taking the pills is not enough. For the patient to quit drinking, he should attend Alcoholics Anonymous or another support group. He should go to the meetings regularly, as well as keeping up his medication. This is important if he wants to stay sober.
TETD Side Effects
TETD has relatively few side effects. The drug has been taken by millions of people for fifty years, and there are few known side effects. These are evident only in extreme or special cases. The side effects mentioned below should be considered a worst-case scenario. As drugs go, TETD is relatively safe and side-effect free.
The most common side effect of TETD is drowsiness. For about one in every twenty TETD users, some general drowsiness occurs in the first couple of months. In cases where it does occur, it usually only lasts about two weeks. The drowsiness is rarely bad, but if it is, the dosage can be decreased for a short period of time, until the body gets used to it. If there are any other minor side effects, cutting the dosage in half for the first two weeks or so is effective.
There is one serious side effect. If there is any sign of liver trouble or hepatitis, TETD must immediately be stopped. This is important.
In some fairly isolated cases, patients have experienced asthenia, dyspnea, hypertension, vasodilatation, sweating, problems with their taste buds, impotence, dizziness, neurological problems, amblyopia and ataxia. Cases are very rare, but it is worth mentioning.
It is very important when taking TETD to make sure any other medications you are taking are okay. TETD reacts with certain drugs in adverse ways, in particular Dilantin (also called phenytoin). As always, you should consult your doctor and make sure there will not be any problems. In many instances, it is just a case of adjusting dosage.
Anyone who takes TETD must be clearly informed about what will happen if they drink. There is a special informed consent form that must be signed by the patient. If you are interested in taking TETD, the first step will be a thorough prescreening, including a physical, clood count, SMA-12 Profile, electrocardiogram, electrolyte analysis, urine study, complete medical history and phychiatric examination. Using TETD is serious, and it must be determined to be safe before the process can begin. After the consent form is signed and all the pre-screening is evaluated and determined to be safe, you can start taking TETD.
The usual dosage of TETD is 500 mg per day, but the doctor will probably start you out at 250 mg for the first week or so, and then up the dosage. This will allow your body a chance to get used to it. But remember, TETD is only part of the rehabilitation process. It also includes attending meetings and learning to cope without drinking.
During the process, you will not have to return to the doctor unless a problem develops. You will have to go back for another SMA-12 after a few weeks of taking TETD, but after that you are finished. Make sure that if there is any indication of liver trouble, you stop taking TETD immediately.
If you have trouble with TETD, a safe and effective alternative is Metronidazole (also called Flagyl). Flagyl is more suitable if you suffer from heart trouble, phychosis, cerebral damage, or if you are pregnant.
Flagyl is similar to TETD in most ways. One difference between the two is the severity of the reaction to alcohol. Flagyl has a much milder reaction, and that is part of why it may be safer for some patients. However, it has been reported that some patients have abused flagyl because of the 'rush' they get from the reaction with alcohol.
How To Deal With A Reaction
It is generally believed that ascorbic acid does not help treat the TETD-ethanol reaction. However, it has been seen that in the case of a mild reaction, asorbic acid has been effective in treating it. A mild case would be one where the patient's heart rate stays under 100 beats a minute, and the patient is in good shape otherwise. In this case, give the patient 1g of asorbic acid and the symptoms should disappear in 30 or 45 minutes.
For patients with more severe reactions, where the heart rate jumps up to around 150 beats per minute, it is suggested that the patient receive 1g of asorbic acid intraveneously, and the symptoms should disappear in under five minutes.
A few other drugs which will help mitigate a reaction are 50-100mg of diphenhyclramine (Benadryl) taken intravenously, or chlordiazepoxide (Librium) or other barbiturates.
How TETD Affects The Family
Excessive drinking is a family problem, and the whole family must be included in the solution. TETD is just one part of an overall rehabilitation program, including organizations like Alcoholics Anonymous, and family support. It is important for the patient to not only get sober, but stay sober. For this reason, a person close to the patient should be there to help with the use of TETD. It is important to watch and make sure the correct dosage is being taken. This will take up to a year to be totally effective. From then on, it is easier for a sober individual to take care of their own rehabilitation.
Even after that year is over and the patient is completely sober, he should always keep some TETD on hand in case of a relapse. If he starts drinking again, it is easy enough to continue TETD therapy. It is good to keep some on hand in case there is another problem.
] [