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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is Disulfiram Advisable For An Alcohol Addict With Liver Cirrhosis?

Dear Doctor, my father was diagnosed with liver cirrhosis a few months ago....he has been drinking everyday for about 40 years now on a daily basis....he is taking medication for cirrohsis since 3 months, but, he has not stopped taking alcohol....he is 60 years old and his Doctor said his liver is damaged about 60-70%. We were told by one of our family friends that some doctors prescribe Disulfiram 250 mg which will make him stop taking any more alcohol as it will cause severe head aches, asthma, vomitings, chest pain, arrhythmia and in severe cases may lead to heart attacks... My father would not like to go for rehabilitation center or he would not listen to anybody. We cannot seem to find any other solution for his situation... I would truly appreciate if you can advise us on this. Thank you. Sri Ravali Mikkilineni
Tue, 5 Apr 2016
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General & Family Physician 's  Response
Hello dear
Understand your concern.
Your father required psychiatric consultation and rehabilitation.
Explain him about hazards of alcohol by pictures, story and role play.
Do not keep alcohol in near by him.
Family support is must needed.
After withdraw of alcohol, maintenance pahse must required to reduce withdrawl symptoms

I think he should not take the dislufiram , as his liver is already damage.

Disulfiram is used as adjuvant for maintaining abstinence in chronic alcohol dependence.
Disulfiram prevents the breakdown of alcohol by irreversibly blocking the enzyme acetaldehyde dehydrogenase.
Side effects are:
facial flushing, headache, palpitations, tachycardia, dyspnoea, nausea and vomiting.

It last for several hours with peak levels occurring at 8-12 hours.
The action lasts for 7 days after the last dose
But not the contraindication of disulfiram:
Consumed alcohol in the last 24hrs
Recent MI, angina, cardiac failure and uncontrolled hypertension History of CVA
Severely deranged LFT –
GGT>3X normal reference limit (f=120U/L, m=180U/L)
- Bilirubin>30μmol/l
- ALT >150U/L
Known hypersensitivity

So i Think you should do liver test and if it is deranged as above, stop the disulfiram.

Give following treatment:
Counseling
Individual and group therapy
Cognitive-behavioral therapy
Motivational interviewing
Motivational enhancement therapy
Couples and family therapy
Drugs:
Benzodiazepines drug: anti-anxiety drugs used to treat withdrawal symptoms
Naltrexone/ Acamprosate reduces the craving for alcohol.
topiramate and gabapentin can be used

Diet:
Give mutivitamin tablet mostly Vitamin B1, anti oxidant tablet
Healthy calorie rich diet. Diet rich in complex carbohydrate.
Avoid fatty food.

Avoid people and places that make drinking the norm
Join a self-help group
Enlist the help of family and friends
Make new hobby or volunteer work with church or civic groups.
Start exercising: brisk walking, musical therapy, breathing exercise

Hope this may help you.
Best regards
Dr. Sagar
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Is Disulfiram Advisable For An Alcohol Addict With Liver Cirrhosis?

Hello dear Understand your concern. Your father required psychiatric consultation and rehabilitation. Explain him about hazards of alcohol by pictures, story and role play. Do not keep alcohol in near by him. Family support is must needed. After withdraw of alcohol, maintenance pahse must required to reduce withdrawl symptoms I think he should not take the dislufiram , as his liver is already damage. Disulfiram is used as adjuvant for maintaining abstinence in chronic alcohol dependence. Disulfiram prevents the breakdown of alcohol by irreversibly blocking the enzyme acetaldehyde dehydrogenase. Side effects are: facial flushing, headache, palpitations, tachycardia, dyspnoea, nausea and vomiting. It last for several hours with peak levels occurring at 8-12 hours. The action lasts for 7 days after the last dose But not the contraindication of disulfiram: Consumed alcohol in the last 24hrs Recent MI, angina, cardiac failure and uncontrolled hypertension History of CVA Severely deranged LFT – GGT 3X normal reference limit (f=120U/L, m=180U/L) - Bilirubin 30μmol/l - ALT 150U/L Known hypersensitivity So i Think you should do liver test and if it is deranged as above, stop the disulfiram. Give following treatment: Counseling Individual and group therapy Cognitive-behavioral therapy Motivational interviewing Motivational enhancement therapy Couples and family therapy Drugs: Benzodiazepines drug: anti-anxiety drugs used to treat withdrawal symptoms Naltrexone/ Acamprosate reduces the craving for alcohol. topiramate and gabapentin can be used Diet: Give mutivitamin tablet mostly Vitamin B1, anti oxidant tablet Healthy calorie rich diet. Diet rich in complex carbohydrate. Avoid fatty food. Avoid people and places that make drinking the norm Join a self-help group Enlist the help of family and friends Make new hobby or volunteer work with church or civic groups. Start exercising: brisk walking, musical therapy, breathing exercise Hope this may help you. Best regards Dr. Sagar