Disulfiram Treatment Protocol for Chronic Alcoholism
Disulfiram should be avoided in patients with severe alcoholic liver disease due to potential hepatotoxicity, with baclofen being the preferred medication for patients with alcoholic liver disease. 1, 2
Initial Assessment and Preparation
- Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours 3
- Screen drinking habits using validated tools such as AUDIT (Alcohol Use Disorders Identification Test), which is considered the gold standard screening test for alcohol abuse and dependence 1
- Assess liver function prior to starting treatment, as disulfiram is contraindicated in patients with severe alcoholic liver disease 1, 2
Dosage Protocol
- Initial dosage: Maximum of 500 mg daily in a single dose for one to two weeks 3
- Maintenance dosage: Average of 250 mg daily (range 125-500 mg), not to exceed 500 mg daily 3
- Administration timing: Usually taken in the morning, but may be taken at bedtime if sedative effects occur 3
- Dosage adjustment: May be adjusted downward to minimize or eliminate sedative effects 3
Duration of Treatment
- Daily, uninterrupted administration must continue until the patient is fully recovered socially and has established a basis for permanent self-control 3
- Maintenance therapy may be required for months or even years, depending on the individual patient 3, 4
- Disulfiram is probably effective in reducing the frequency of alcohol consumption in compliant patients over the short term (e.g., 6 months) 4
Monitoring and Supervision
- Regular clinical supervision and monitoring for efficacy and side effects are essential 4
- Supervised administration improves compliance and effectiveness 4, 5
- Monitor potassium levels, particularly in patients on digitalis, as hypokalemia has been reported 3
- Regular liver function tests should be performed to monitor for potential hepatotoxicity 2
Management of Disulfiram-Alcohol Reaction
- For severe reactions: Implement supportive measures to restore blood pressure and treat shock 3
- Additional recommendations include:
- Oxygen or carbogen (95% oxygen and 5% carbon dioxide) administration
- Intravenous vitamin C in massive doses (1 g)
- Ephedrine sulfate
- Antihistamines intravenously 3
Important Considerations and Contraindications
- Disulfiram should be avoided in patients over 50 years of age for test reactions 3
- Contraindicated in patients with severe alcoholic liver disease due to potential hepatotoxicity 1, 2
- Not recommended as monotherapy; must be combined with counseling and other therapeutic measures 4, 5
- Brief motivational interventions should be routinely used alongside pharmacological management 1
Alternative Pharmacotherapies for Patients with Liver Disease
- Baclofen is the preferred medication for patients with alcoholic liver disease, as it has demonstrated safety and efficacy in promoting alcohol abstinence in patients with liver cirrhosis 1, 2
- Acamprosate may be considered as an alternative, as it reduces withdrawal effects and craving for alcohol 2, 5
- Naltrexone is not recommended for patients with alcoholic liver disease due to risk of hepatotoxicity 2
Efficacy Considerations
- Disulfiram may help reduce drinking frequency after relapse but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence 6
- Most effective when combined with a structured, supervised aftercare program 7
- At the usual dosage of 250 mg/day, disulfiram does not appear to significantly increase the risk of psychiatric complications or psychiatric drug interactions 7