Disulfiram use in substance abuse

Q;  44 years old male with history of alcohol (ETOH) and cocaine abuse disorder is admitted to ICU with hypertensive crisis. Patient is now recovering in ICU. In the morning multi-disciplinary round, Disulfiram has been suggested to be added in his med profile before transfer to floor. Disulfiram can be used in the treatment of which disorder? (select one)

A) ETOH

B) Cocaine 

C) Both

Answer: C

Disulfiram is well known to have efficacy in ETOH abuse. It also has some promising potential in the treatment of cocaine use disorder. Disulfiram affects the cocaine use by decreasing the reinforcing properties of cocaine. It makes the use of cocaine aversive. 

Disulfiram works via two mechanisms:

1. It blocks the degradation of cocaine by plasma esterases. This leads to extremely high cocaine levels.

 

2. It blocks the conversion of dopamine to norepinephrine by the enzyme dopamine beta-hydroxylase. This alters the dopamine/norepinephrine balance in neurons.

These effects enhance the likelihood of cocaine abstinence.

Moreover, when disulfiram is combined with naltrexone, it provides better-sustained abstinence from both cocaine and alcohol. The recommended dose for disulfiram is 250 mg daily and for naltrexone is 100 mg daily.

#toxicology

References:

1. McCance-Katz EF, Kosten TR, Jatlow P. Disulfiram effects on acute cocaine administration. Drug Alcohol Depend 1998; 52:27.

2. Hameedi FA, Rosen MI, McCance-Katz EF, et al. Behavioral, physiological, and pharmacological interaction of cocaine and disulfiram in humans. Biol Psychiatry 1995; 37:560.

3. Carroll KM, Nich C, Ball SA, et al. Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction 1998; 93:713.

4. Pettinati HM, Kampman KM, Lynch KG, et al. A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence. Addict Behav 2008; 33:651.