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Pesticides and Chronic Diseases
Published in William J. Rea, Kalpana D. Patel, Reversibility of Chronic Disease and Hypersensitivity, Volume 4, 2017
William J. Rea, Kalpana D. Patel
Both thiram and disulfiram inhibit aldehyde dehydrogenase and are therefore capable of inducing “Antabuse” reactions in persons who consume the beverage with alcohol following substantial absorption of dithiocarbamates. Reactions may have occurred rarely in workers who imbibed alcohol after extraordinary occupational exposure to thiram. Theoretically, the metallodithiocarbamates may also predispose to an “Antabuse” reaction. Peripheral vasodilation is the main pathophysiologic feature of the disulfiram–alcohol reaction, probably due to high tissue levels of acetaldehyde. This type of exposure may occasionally lead to shock and even more rarely to myocardial ischemia, cardiac arrhythmias, circulatory failure, and death. Animal experimentation has suggested certain other biochemical mechanisms of toxicity involving reaction products of ethanol and disulfiram. Frequently, a subset of chemically sensitive individuals has this peripheral dilation phenomenon. Possibly, inhalation, ingestion, or absorption of other nonliquor alcohols will trigger this response in them.
Pharmacotherapeutic options for co-morbid depression and alcohol dependence
Published in Expert Opinion on Pharmacotherapy, 2019
Thomas Hillemacher, Helge Frieling
Disulfiram has been used for almost 60 years in the treatment of alcoholism and was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat chronic alcohol dependence. Disulfiram blocks the enzyme aldehyde dehydrogenase resulting in the accumulation of acetaldehyde upon ethanol ingestion. This produces the aversive ‘Antabuse reaction’ with tachycardia, flushing, nausea, and vomiting. Before administering disulfiram, the clinician should inform patients and their families about the disulfiram-alcohol reaction, including that this reaction may occur for up to 14 days between the last ingested dose of disulfiram and alcohol consumption. Disulfiram has also been shown to modulate noradrenergic and dopaminergic neurotransmission. The efficacy of disulfiram in treating detoxified depressed alcohol-dependent patients was first examined by Goyer et al. [42]. The 3-week double-blind study with disulfiram (250 mg/day or 500 mg/day) or placebo found no significant differences due to drug condition on rating of depression [42]. Another 12-week placebo-controlled, randomized study with disulfiram in combination with the anti-craving compound naltrexone or placebo in comparison to naltrexone in monotherapy showed more promising results and proved that disulfiram can be used effectively and safely in individuals with current depression and alcohol dependence [43]. All groups showed decreased alcohol versus placebo. However, there was no advantage in any of the measures of alcohol consumption for subjects who received both medications versus those treated with either active medication alone [43].
Alcohol addiction - the safety of available approved treatment options
Published in Expert Opinion on Drug Safety, 2018
Mariangela Antonelli, Anna Ferrulli, Luisa Sestito, Gabriele A. Vassallo, Claudia Tarli, Carolina Mosoni, Maria M. Rando, Antonio Mirijello, Antonio Gasbarrini, Giovanni Addolorato
Alcohol consumption is absolutely contraindicated during pregnancy due to its toxic effects to the fetus. Although the prevalence of AUDs in pregnant women is low [108], total alcohol abstinence is recommended as soon as possible for pregnant women affected by AUD [109]. In case of withdrawal symptoms, benzodiazepines can be prescribed for the prevention and treatment of AWS given their safety during pregnancy [110,111]. On the contrary, there is a lack of studies assessing the safety of anticraving drugs on fetus. Thus, the prescription of a pharmacological treatment to pregnant women with AUD for the prevention of alcohol relapse is not recommended [112]. However, given the case of a pregnant women with a preexisting AUD treated with anticraving drugs, the risks and benefits of continuing pharmacological treatment should be evaluated case-by-case [113]. The only drug that must be stopped in case of pregnancy is disulfiram, given the well-known increased risk of fetal malformations during the first trimester [112,113]. Moreover, there is a risk to develop severe hypertension and autonomic instability both for women and for fetus due to disulfiram-alcohol reaction.