Medications for Alcohol Use Disorder and Predicting Severe Withdrawal

Saitz, Richard

doi:10.1001/jama.2018.10061

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…Moreover, experiencing a DER seems not to be associated with any differences in treatment outcome but with a significant earlier discontinuation of DIS therapy [47]. Other publications [1,3,4] concluded that PLOS ONE the drug is valuable but in these, adequate supervision was guaranteed. In this respect immediate recognition and treatment of a DER in the ED is an important aspect of DIS therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Disulfiram (DIS) is primarily used as an adjunct in the treatment of alcohol use disorders [1][2][3][4]. DIS and its active metabolite S-methyl N,N-diethylthiocarbamate sulfoxide irreversibly inhibit the enzyme aldehyde dehydrogenase which leads to the accumulation of acetaldehyde with effects known as a DIS ethanol reaction (DER) [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Recovery of enzymatic activity depends on de novo aldehyde dehydrogenase synthesis that takes place in 6 or more days [7]. A DER may occur after even small quantities of alcohol which usually leads to an unpleasant reaction [3]. A DER has been described occasionally after ingestion of either food cooked in alcohol or alcohol-based sauces and following excessive use of alcohol-containing cosmetics [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

et al. 2020

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Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

et al. 2020

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“…This sentiment is not a deviation of care as these medications have been discussed in other prominent medical journals regarding pharmacotherapy for alcohol use disorder, including the New England Journal of Medicine 4 and the Journal of American Medical Association. 5,6 Finally, the authors note that a reduction in drinking alone is a nonvalid surrogate. We are aware of the recommendation of the American Institute of Cancer Research for total abstinence from alcohol stemming from the current literature, which suggests a causal link between US dietary guidelineebased moderate alcohol consumption and cancer.…”

mentioning

confidence: 98%

“…As a general rule, off-label use is about caveats, not promises: (1) exposing patients to the unnecessary risk of many adverse events, including mortality, for an all-too-often uncertain efficacy, 5 and (2) hindering the development of evidence-based medicine and therapeutic innovation.…”

mentioning

confidence: 99%