Description
Teturam Pharmacodynamics
During metabolism, ethanol is metabolized in the liver by the enzyme acetaldehyde dehydrogenase. Disulfiram irreversibly inhibits acetaldehyde dehydrogenase, which leads to increased concentration of ethanol metabolite – acetaldehyde. After taking ethanol during disulfiram treatment, the concentration of acetaldehyde increases and certain unpleasant feelings develop (“rushes” of blood to the skin, nausea, vomiting, tachycardia, lowering of blood pressure). As a result, a conditioned reflex reaction to the taste and smell of ethanol occurs. Maximum therapeutic effect is achieved 12 hours after oral administration and may last for 10-14 days after discontinuation of treatment.
Indications
Treatment and prevention of relapse in chronic alcoholism.
Contraindications .
– Hypersensitivity to disulfiram or excipients of the drug.
– Severe hepatic insufficiency.
– Respiratory insufficiency of a heavy degree.
– Renal insufficiency of a severe degree.
– Diabetes mellitus.
– Stroke in the history or severe organic lesions of the brain.
– Neuropsychiatric disorders.
– Epilepsy and seizure syndrome of any genesis.
– Diseases of the cardiovascular system, including coronary heart disease.
– Consumption of alcoholic beverages or medications containing ethanol within the preceding 24 hours.
– Pregnancy and childbearing age (in the absence of contraception).
– Breast-feeding period.
– Childhood under 18 years of age (due to lack of efficacy and safety data).
– Concomitant use of isoniazid, metronidazole, ornidazole, secnidazole, tinidazole, phenytoin (see section “Interaction with other medicinal products”).
Caution
– Renal insufficiency (risk of more severe disulfiram-ethanol reaction).
– Hypothyroidism (risk of more severe disulfiram-ethanol reaction).
– Nickel dermatitis (increased risk of developing hepatitis).
– Gastric and duodenal ulcer (see section “Side effects”). – Optic neuritis (see section “Side effects”).
– In patients taking cocaine (risk of QT interval prolongation, see section “Interaction with other medicinal products”).
– Patients over 60 years of age.
Dosage and administration
- Treatment is administered after careful examination of the patient and warning about the consequences and complications. The patient should not take alcohol (ethanol) 5-7 days before the start of treatment, the test for ethanol in the blood should be negative. The dose may be varied up or down depending on the patient’s response.
- Disulfiram-ethanol test
- Disulfiram-ethanol test shall be carried out 7-10 days later (after taking 500 mg of the drug, the patient shall take 20-30 ml of 40% ethanol). In case of weak disulfiram-ethanol reaction (blood rush to the face, skin hyperemia, nausea, vomiting, weakness, tachycardia, reduced arterial pressure), the ethanol dose shall be increased by 10-20 ml (maximum dose is 120 ml in recalculation on 40% ethanol). The test is repeated in 1-2 days in the hospital and 3-5 days later as an outpatient, with correction of doses of ethanol and/or the drug as necessary. Thereafter, the drug may be used in a maintenance dose of 150 mg per day for 1-3 years.
- Disulfiram-ethanol testing is not recommended in patients over 50 years of age.
