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Substance Abuse during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Naltrexone has been used to treat several substance dependencies during pregnancy without apparent untoward effects, but no long-term follow-up studies have been published (Hulse et al., 2001). An alternative therapy with little or no potential for abuse is buprenorphine/naloxone (Suboxone), but there are no studies of its use during pregnancy. Disulfiram (Antabuse), a deterrent for alcohol abuse, should not be used at any time during pregnancy because of its strong copper-chelating properties. Copper is essential to normal fetal neuronal formation and migration, and any impediment in these processes may result in fetal brain malformations. Notably, this is a theoretical risk.
Biological Approaches
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Tricia L. Chandler, Mary C. Hoke, Tara G. Matthews, Elizabeth Reyes-Fournier
Disulfiram is one of the more common drugs used to treat alcohol use disorder and the first medication approved by the US Food and Drug Administration (FDA). It works by inhibiting aldehyde dehydrogenase – a key enzyme involved in the breakdown of ethyl alcohol (Schatzberg & Nemeroff, 2013). It is considered most effective for individuals who have completed detoxification and are in the initial stage of abstinence. There are some common unpleasant side effects that can occur as soon as ten minutes after drinking even a small amount of alcohol and can last one or more hours. These side effects include nausea, headache, vomiting, chest pains, and difficulty breathing. The half-life of Disulfiram is 60 to 120 hours. It is contraindicated if an individual has been diagnosed with cardiovascular disease or a psychosis (Stahl, 2017).
Classes of Drugs Needed for the Successful Management of Addictions
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
The alcohol-disulfiram reaction begins within 30 min of the ingestion of alcohol; usually at least 10 g of alcohol (the amount in a usual portion of an alcoholic beverage) are required for the patient to perceive a reaction. The small amount of alcohol in medicines, cooking condiments, or absorbed from shaving lotions is too small to produce a reaction. Most reactions seen by physicians follow multiple drink ingestions. There is a marked vasodilatation, a feeling of warmth and excitement, usually occurring within 30 min of alcohol ingestion. The heart pounds, there is headache, increasing anxiety, and usually some element of nausea and vomiting. At a dose of 250 mg/day and a challenge of 10 to 15 g of ethanol (one drink), some 80% of people get a mildly unpleasant reaction. If a patient gets no reaction, it is appropriate to increase the dose of disulfiram.
Promising treatment strategies to combat Staphylococcus aureus biofilm infections: an updated review
Published in Biofouling, 2020
P. S. Seethalakshmi, Riya Rajeev, George Seghal Kiran, Joseph Selvin
Disulfiram is an FDA approved medication used as an aversive agent in patients with chronic alcoholism (Ellis and Dronsfield 2013). Recent studies have proven that disulfiram has antimicrobial potential against antibiotic-resistant bacteria such as Mycobacterium tuberculosis and S. aureus (Horita et al. 2012; Long 2017). Disulfiram eradicated S. aureus biofilms much more effectively than the antibiotics levofloxacin, and vancomycin (Thakare et al. 2019). Besides biofilms, intracellular reservoirs of S. aureus can also lead to recurrent infections (Fowler et al. 2005). Disulfiram showed efficient elimination of intracellular S. aureus from infected mouse macrophage cells and a reduced bacterial load in mouse models. The MIC value of disulfiram did not differ with respect to virulence factors and was equally effective against antibiotic-resistant and sensitive strains of S. aureus, suggesting a novel inhibitory mechanism (Thakare et al. 2019). Given below is a summary of drugs that have been repurposed as anti-biofilm agents of S. aureus (Table 2; Figure 3).
Pharmacotherapeutic management of co-morbid alcohol and opioid use
Published in Expert Opinion on Pharmacotherapy, 2020
Lauren E. Hood, Jonna M. Leyrer-Jackson, M. Foster Olive
Disulfiram is intended to provide aversive conditioning against alcohol to promote abstinence. Disulfiram causes increased sensitivity to the negative effects of alcohol by inhibiting acetaldehyde dehydrogenase 2 (ALDH2), an important enzyme for metabolizing acetaldehyde to acetate. Acetaldehyde is the first byproduct of alcohol oxidation, and when disulfiram is metabolized in the presence of alcohol, the lack of functional ALDH2 leads to the accumulation of acetaldehyde in the bloodstream. The increased concentration of acetaldehyde causes unpleasant symptoms characteristic of a severe hangover, including nausea, vomiting, headaches, and low blood pressure [2]. The severity of the reaction experienced is dependent on the dose of disulfiram and the amount of alcohol consumed, and has the potential to be fatal under some circumstances [81]. In the absence of alcohol, disulfiram induces minor side effects including drowsiness, headaches and an increased risk for heptatoxicity that is preventable if monitored properly [81]. In the same mechanistic vein, mutations in the Aldh2 gene that impede acetaldehyde metabolism appear to be protective against AUDs. For example, the ALDH2.2 allele, predominantly expressed in Asian populations, encodes a nonfunctional form of the enzyme and confers sensitivity to alcohol, most frequently characterized by facial flushing [83,84].
Patient perspectives on alcohol use disorder pharmacotherapy and integration of treatment into primary care settings
Published in Substance Abuse, 2019
Sean J. Haley, Erika A. Pinsker, Heather Gerould, Jennifer P. Wisdom, Hildi J. Hagedorn
For the qualitative interview sample, 30 veterans completed interviews across 3 large VHA medical centers. Nearly all (n = 29, 97%) were male, with an average age of 41 (SD = 21; range = 25–72). Six (20%) reported race as African American, 1 (3%) as Hispanic/Latino, and 23 (77%) as white. Fifteen (50%) reported serving in Vietnam and post-Vietnam, and 11 (37%) reported serving in Afghanistan/Iraq. Twenty-two respondents (73%) were receiving AUD treatment, and 7 (23%) had been previously treated for AUD. Twenty-one patients had spoken with their primary care provider about their alcohol use. Of the 15 alcohol medication-naïve patients, 6 stated that they would be willing to try pharmacotherapy, 5 stated that they were unlikely, 2 identified reservations, 1 said no, and 1 was not asked. Fifteen patients were either currently taking medications (n = 10) or had taken medication in the past (n = 7; 2 patients had past and current experience). Of the 5 patients who had tried pharmacotherapy in the past but were not currently taking an AUD medication, 3 were willing to try medication again. Two patients who had used disulfiram said that they would not recommend it. Ten patients with either current or past medication experience were willing to recommend a medication to others.