Antabuse/Disulfiram - How careful do you have to be with food, cologne, etc....
Kelcey
some of the posts.
I requested from my doctor Antabuse/Disulferam 250 MG tablets to help
motivate me to not drink.
I obviously have a drinking problem.
I was wondering if any one of you have had any experience with this
drug? What I am worried about is the interactions that I may have with
food, colognes, lotions and stuff, but basically food.
I understand vinegar is on the list of condiments to avoid. Is this
really true? I guess I'd like to know how careful I need to be with
foods in general.
For instance, if I go to a Chinese or Japanese restaurant, should I
avoid soy sauce, which is made from fermented soy beans?
What about white vinegar in some sauces (Ketchup)? I looked up "white
vinegar" and it said it was made by fermenting an ethyl alcohol
solution of some sort. Now, I like to use white vinegar a lot, so
this is kind of an important question to me.
I didn't realize there was alcohol in so many products and I wonder
how careful do I need to be.
If I spray cologne on my skin will that usually be enough to cause a
reaction?
Gosh, I have so many questions that may or may not be answered
definitely regarding interactions with common items, but I would like
some input from people who have had some experinece with this drug.
In any case, I wish everyone luck in their endeaver, including myself!
Thanks!
Kelcey
Bill Johnston, 11 Greenfield St., Buffalo, NY, 14214 (716) 838-3038
or, read:
Disulfiram
Brand name: Antabuse
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Drug monograph
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Contents
Pharmacology
Indications
Contraindications
Warnings
Precautions
Adverse Effects
Overdose
Dosage
Supplied
Research
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Pharmacology
Antialcoholic
Disulfiram produces a sensitivity to alcohol which results in a highly
unpleasant reaction when the patient under treatment ingests even small
amounts of alcohol. Disulfiram blocks the oxidation of alcohol at the
acetaldehyde stage. During alcohol metabolism after disulfiram intake, the
concentration of acetaldehyde occurring in the blood may be 5 to 10 times
higher than that found during metabolism of the same amount of alcohol
alone.
Accumulation of acetaldehyde in the blood produces a complex of highly
unpleasant symptoms referred to as the disulfiram-alcohol reaction. This
reaction, which is proportional to the dosage of both disulfiram and
alcohol, will persist as long as alcohol is being metabolized. Disulfiram
does not appear to influence the rate of alcohol elimination from the body.
Disulfiram plus even small amounts of alcohol produces flushing, throbbing
in head and neck, throbbing headache, respiratory difficulty, nausea,
copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea,
hyperventilation, tachycardia, hypotension, syncope, marked uneasiness,
weakness, vertigo, blurred vision, and confusion. In severe reactions, there
may be respiratory depression, cardiovascular collapse, arrhythmias,
myocardial infarction, acute congestive heart failure, unconsciousness,
convulsions, and death. The intensity of the reaction may vary with each
individual but is generally proportional to the amount of disulfiram and
alcohol ingested. In the sensitive individual, mild reactions may occur when
the blood alcohol concentration is increased to as little as 5 to 10 mg/100
mL. At a concentration of 50 mg/100 mL symptoms are usually fully developed,
and when the concentration reaches 125 to 150 mg/100 mL unconsciousness may
occur.
The duration of the reaction is variable, from 30 to 60 minutes in mild
cases, up to several hours in more severe cases or as long as there is
alcohol remaining in the blood. In severe reactions, supportive measures to
restore blood pressure and treat shock should be instituted. Other measures
such as the administration of oxygen or carbogen (95% oxygen, 5% carbon
dioxide), massive i.v. doses of vitamin C (1 g), ephedrine sulfate, or
antihistamines i.v. might be indicated. Potassium levels should be monitored
particularly in patients on digitalis since hypokalemia has been reported.
Disulfiram is slowly absorbed from the gastrointestinal tract and is slowly
eliminated from the body. Ingestion of alcohol may produce unpleasant
symptoms 1 or even 2 weeks after a patient has taken his last dose of
disulfiram.
Prolonged administration of disulfiram does not produce tolerance. The
longer a patient remains on therapy the more sensitive he becomes to
alcohol.
Pharmacokinetic data are not clearly established; however, it has been shown
that 80 to 95% of an ingested dose is absorbed from the gastrointestinal
tract and rapidly distributed to tissues and organs: liver, spleen,
adrenals, fatty tissues, and brain. It is then metabolized to
diethyldithiocarbamate or mixed disulfides, one of the end products being
carbon disulfide. The unabsorbed fraction is excreted in the feces, the
intermediate and final metabolites are excreted in the urine, and the
volatile metabolites in the breath.
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Indications
As an aid in the management of selected chronic alcoholic patients who want
to remain in a state of enforced sobriety so that supportive and
psychotherapeutic treatment may be applied to best advantage.
Used alone, without proper motivation and without supportive therapy,
disulfiram is not a cure for alcoholism, and it is unlikely that it will
have more than a brief effect on the drinking pattern of the chronic
alcoholic.
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Contraindications
Patients who are receiving or have recently received metronidazole,
paraldehyde, alcohol, or alcohol-containing preparations such as cough
syrups, elixirs, should not be given disulfiram. Severe myocardial disease
or coronary occlusion; diabetes mellitus; hepatic cirrhosis or
insufficiency; hypothyroidism; epilepsy; cerebral damage; chronic and acute
nephritis; psychoses; and hypersensitivity to disulfiram or other thiuram
derivatives used in the manufacture of items such as pesticides or
vulcanized rubber.
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Warnings
Disulfiram should never be administered to a patient without his full
knowledge or when he is in a state of alcohol intoxication. The attending
physician should instruct those tending the patient accordingly.
Patients must be fully informed about the disulfiram-alcohol reaction. They
must be strongly cautioned against surreptitious drinking while taking the
drug and must be fully aware of possible consequences. They should be warned
to avoid alcohol in disguised form, i.e., in sauces, vinegars, cough and
cold mixtures, and even aftershave lotions or liniments. They should also be
warned that reactions may occur with alcohol up to 14 days after ingestion
of disulfiram.
For recommendations regarding management of the disulfiram reaction, see
Pharmacology.
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Precautions
Patients should be informed of the type of reaction which will be
encountered if alcohol is taken overtly or as a component of food or other
products (see Pharmacology).
Patients having a history of industrial contact dermatitis who currently
work or have previously worked in the rubber industry should be evaluated
for hypersensitivity to thiuram derivatives before receiving disulfiram (see
Contraindications).
Patients exposed to organic solvents which may contain alcohol,
acetaldehyde, paraldehyde or structural analogues are at risk of
experiencing disulfiram alcohol reactions. Such exposure should be
eliminated prior to treatment.
It is suggested that every patient under treatment carry an identification
card stating that he is receiving disulfiram and describing the symptoms
most likely to occur as a result of the disulfiram-alcohol reaction. In
addition, this card should identify the attending physician or institution
to be contacted in emergency. (Cards may be obtained from Ayerst upon
request.)
Alcoholism may be associated or followed by dependence on narcotics or
sedatives. Barbiturates have been administered concurrently with disulfiram
without untoward effects, but the possibility of initiating a new dependence
should be considered. Patients taking disulfiram should not be exposed to
ethylene dibromide or its vapors. This precaution is based on animal studies
which have suggested a possible toxic reaction between inhaled dibromide and
ingested disulfiram. Rats exposed to this regimen have shown a higher
incidence of tumors and mortality. Correlation of this finding in humans
however has not been demonstrated.
Since disulfiram-alcohol reactions could aggravate some medical conditions
such as diabetes mellitus, hypothyroidism, epilepsy, cerebral damage,
chronic and acute nephritis, hepatic cirrhosis or hepatic insufficiency,
disulfiram should be used with extreme care in patients having such a
medical history. Baseline and follow-up transaminase tests (10 to 14 days)
are suggested to detect any hepatic dysfunction that may be associated with
disulfiram therapy. In addition, a complete blood count and a sequential
multiple analysis-12 test (SMA-12) should be carried out every 6 months.
Disulfiram inhibits enzyme induction and may thus interfere with the
metabolism of drugs taken concomitantly. It enhances the effects of the
coumarin anticoagulants and phenytoin. Consequently, in patients on oral
anticoagulants, such dosage should be adjusted. In patients on phenytoin
therapy, a baseline phenytoin serum level should be obtained before
initiation of disulfiram therapy. After initiation of therapy, serum levels
should be reevaluated on different days for evidence of an increase or
continuing rise in levels. Appropriate dosage adjustment should be made, if
elevated levels are found. Disulfiram should be discontinued in patients
taking isoniazid if an unsteady gait develops or there are marked changes in
mental state.
Carcinogenicity and mutagenicity data are not clearly established. In rats,
simultaneous ingestion in the diet of disulfiram and nitrite for 78 weeks
has been reported to cause tumors. It has been suggested that conversion of
nitrite to nitrosamines in the stomach could be responsible for the
development of the tumors. Disulfiram alone did not lead to tumor
development. The relevance of these findings to humans is not known at this
time.
In one study, disulfiram had deleterious effects on the reproductive cycle
and reproductive capabilities of female rats, and the growth of their pups.
In another study, no adverse effect on fertility was noted. Studies in the
hamster, rat, and mouse have not produced any teratogenic effect in the
offspring.
Pregnancy and Lactation:
It is not known whether disulfiram can cause fetal harm when administered
during pregnancy, but one report of limb reduction anomalies in infants born
to disulfiram-treated mothers has been published. Because of these findings,
extreme care should be exercised before administering disulfiram during
pregnancy.
It is not known whether this drug is excreted in human milk. Since many
drugs are, and because of the potential for serious adverse reactions in the
nursing infants, before administering disulfiram to a nursing mother it
would appear advisable to discontinue nursing.
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Adverse Effects
Optic neuritis, peripheral neuritis, polyneuritis may occur following
administration of disulfiram. Multiple cases of both cholestatic and
fulminant hepatitis have been reported following administration of the drug.
Occasional skin eruptions have been reported. In a small number of patients,
a transient mild drowsiness, fatigue, impotence, headache, acneiform
eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may
be experienced during the first 2 weeks of therapy. These complaints usually
disappear later during therapy or with reduced dosage. Psychotic reactions
have been noted, in most cases attributable to high dosage, associated
toxicity with other drugs (metronidazole or isoniazid), or the unmasking of
underlying psychoses in patients stressed by withdrawal of alcohol.
Hepatotoxicity has been observed in a few patients.
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Overdose
Symptoms and Treatment:
Severe cases of disulfiram poisoning have been reported mainly in children.
Within a few hours of ingestion of a large amount, drowsiness followed by
coma develop accompanied by persistent nausea, vomiting, aggressive and
psychotic behavior, and ascending flaccid paralysis which can reach the
cranial nerves.
Treatment consists of administration of oxygen therapy, glucose 5% i.v., and
sodium ascorbate 1 g i.v. Patient should be kept in bed and as quiet as
possible with appropriate symptomatic treatment.
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Dosage
Should never be administered until the patient has abstained from alcohol
for at least 12 hours.
Initiation of therapy:
A maximum of 500 mg daily in a single dose should be given for 1 to 2 weeks,
preferably taken in the morning. Patients experiencing a sedative effect may
take the drug at bedtime or, if necessary, dosage may be adjusted downward.
Average maintenance dose is 250 mg daily (range 125 to 500 mg) but should
not exceed 500 mg daily.
Note:
Some patients, while seemingly on adequate maintenance doses, report that
they are able to drink with impunity. Such patients must be presumed to be
disposing of their tablets in some manner without actually taking them.
Until it has been reliably confirmed that these patients have been taking
their daily tablets (preferably crushed and well mixed with liquid), it
cannot be concluded that disulfiram is ineffective.
Duration of therapy:
Daily, uninterrupted administration of disulfiram must be continued until
the patient has established a basis for permanent self-control. Depending on
the individual patient, maintenance therapy may be required for months or
even years.
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Supplied
Each white to off-white round tablet, embossed with the letter A on one side
and a double score line on the other, contains: Disulfiram USP 250 or 500
mg. Also contains cornstarch. Energy: 250 mg, 0.54 kJ (0.13 kcal); 500 mg,
1.13 kJ (0.27 kcal). Alcohol-free, gluten-free, lactose-free, parabens-free,
sugar-free, sulfites-free and tartrazine-free. Bottles of 50 (500 mg).
Bottles of 100 (250 mg).
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Research
The research information is available separately on Internet Mental Health.
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Note: This information is from a Canadian monograph. There can be
differences in indications, dosage forms and warnings for this drug in other
countries.
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Internet Mental Health (www.mentalhealth.com) copyright © 1995-2003 by
Phillip W. Long, M.D.
"Kelcey" <kel...@hawaii.rr.com> wrote in message
news:j12civ0v9j786qtsb...@4ax.com...
Gregg Fowler
tool and I never had any hypersensitivity to foods, lotions or colognes.
Vinegar and soy sauce did not bother me. If you take it for a while, you
need to be free of it for two weeks before you can consume alcohol without
any unpleasant reactions however. It is definitely a good motivator while
you are developing a support network and learning to cope without alcohol.
There are potential side effects, but a lot of them have been hard to
differentiate from pre-existing conditions that may have been present before
quitting, but only became apparent afterwards. Good luck with it. I too just
asked a Doctor for it a few years back and it helped me avoid a lot more
grief or worse at the time.
Gregg
"Kelcey" <kel...@hawaii.rr.com> wrote in message
news:j12civ0v9j786qtsb...@4ax.com...
Michael Rapp
---------------------------
Hi Kelcey,
first of all, I do not have personal experience with Antabuse, but know several
people who do.
Whether it's any good or not depends mostly on your attitud towards drinking and
this drug. If taken alone with no further (professional) guidance, it won't help
you in the long run, it'll be like taking aspirin for a torn ligament, to cool
off the symptoms/ pain, but doing nothing about treatment.
The major work is still ahead of you, to change your way of life. There is no
other way.
As for alcohol as a food supplement, there are as many guidelines as there are
people you ask. Basically they are all right: You should avoid alcohol at all
means. However, this is not always possible (for example, in candy bars they
sometimes put alcohol in as a conservation agent). So I cannot give out a
guideline as a rule, because the reactions vary so much. What may be safe for me
may be fatal to you (or vice versa). Instead, I give you the "rules" I live by:
In restaurants (and at home, of course), avoid sauces made with alcohol (like
wine or sherry). NO excuses here.
At celebrations or parties, NO alcohol, no glass of champagne, nothing alcoholic
under NO circumstances. If somebody tries to bully me into joining him for a
glass, then I leave. For me, the only amount of alcohol I can handle safely is
zero. I found that when I had let myself be persuaded for a glass to toast to
the celebrety, then I became a frequent guest of such occacions. I had gotten
really good at "convincing" myself that this couldn't hurt (needless to say that
I was wrong, of course).
I use cologne, but only once a day. Regular dosis. You might want to watch
yourself closely, but this I only can do after I went through therapy. Before
that, self- honesty is a closed book to alcoholics (general rule here,
exceptions do exist, but I definitely am not one of them. And how certain can
you be that you are the one guy in a thousand?)
I don't eat candy or store- bought cakes, so I don't have to watch that.
Vinegar and soy sauce are a tricky matter. Their alcohol content is virtually
zero, but since in the manufacturing proccess alcohol is involved, it might
trigger something in your base memory, not at concious level (like saccherine
instead of sugar, the body knows it's been cheated and now demands the "real
stuff"). For myself, I use vinegar, ketchup and soy sauce but I listen closely
to my inner self and when I realize something feels strange I'm gonna run like a
scarred rabbit.
If you want to be serious about alcohol in foodstuffs, then the only way is to
cook everything yourself. Mom's cooking won't do because other people don't know
what to look for, really. Like at one instance, when I was just out of therapy,
my dad and I talked about alcohol and avoiding it, and in the course he offered
me an amaretto- flavored cappucino. My point is, he wasn't thinking along my
lines.
As a summary, I will not hand out an absolution on foodstuffs which are ok, that
is your own descision. Talk to doctors (several, and make sure they have
substance abuse training), but bear in mind the descision and responsibility is
always yours.
Regards,
Mike.
Bpyboy
BOIL OFF the alcohol, if you are using maybe some wine. Any good cook doesn't
soak his food in booze. They use the alcohol as a solvent, to extract flavors.
but the booze is boiled off.
I wouldn't suggest eating something called "rum cake" or something like that,
but a tomatoe sauce is nearly always made with some wine in the process. But
again, simmering drives it off (alcohol boils many degrees lower than
alcohol--it works like distillation).
I wouldn't really worry too much about it. As long as you are not DRINKING the
alcohol, the miniscule amount you recieve in food shouldn't hurt you. I mean,
how many people have eaten a ton of sushi or a good Italian meal, and not felt
it (in the alcohol buzz sense)? And you don't taste the beer or wine or sherry
either. It not the overpowering flavor in the dish. (unless it's a shit
resturant--if I can taste the alcohol, i don't like it!)
good luck my friend,
But it's maybe to talk with the dr. who prescribed it than throw you concerns
out into cyberspace? I don't think we have any MDs here, do we? We can only
draw on experience (a good teacher, or a harsh one as the case may be), and the
school of hard knocks. Still, i think if you're interested in eating, eating
as often and as much as possible, and in the absence of booze, you will be on
the road to get at least your BODY back in shape. The MENTAL part, as stated
before, is really the tough one.
talk later
john
rosie readandpost
> before, is really the tough one.
>
> talk later
> john
your right about that!
imo, that is where a good recovery group comes in......................
--
read and post daily, it works!
rosie
learn to recognize the inconsequential, then ignore it.
....................h. jackson brown jr.
"Bpyboy" <bpy...@aol.com> wrote in message news:20030729092946...@mb-m03.aol.com...
pauly
not wanting to avoid alcohol, he NEEDS to because of the potential reaction
with the antabuse. A friend of mine goes into violest spasms of projectile
vomiting if he splashes on a palmful of aftersahve. The reaction to the
alcohol is diferent in all people. Some people can even get drunk whilst
taking antabuse, but not many. The only safe way is to avoid all alcohol at
all costs, even checking your deoderant, and cleaning products. The reaction
can in some cases be deadly, although again this is rare, so it is worth
that little extra effort reading all your labels and asking in restaurants
if in doubt. Hope this helps
bluelotu...@gmail.com
I have learned that a small dose of alcohol, like Kombucha, will cause a bit of flushing and headache which is a warning to consume no further alcohol.
I can use colognes and hand sanitizer son my skin with no symptoms. I am cautious... If in doubt, go very easy at first and pay attention to your body's reaction.
Smoking cigarettes on Antabuse can give me nausea/vomiting, so again, just go slow while you figure out your body's limitations.
I'm going to continue taking the Antabuse because it helps me to stay strong in my commitment to my recovery even in those moments when the Addictive Voice creeps in and sounds tempting.
Good luck! You can do it.
healthph...@gmail.com
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