Esperal (Disulfiram 250mg) Tablets

Esperal general information

What is Esperal used for?

Esperal tablets 250mg are used to treat and manage chronic alcohol dependence as part of an integrated programme of counselling and rehabilitation, to help alcoholics remain alcohol free once they have given up drinking alcohol.  Alcohol dependence or alcoholism is considered an addictive disease that can result in physical and psychological addiction to alcohol.  This addiction can influence all aspects of life, causing dysfunctional behaviour and affecting relationships and the workplace.  Alcoholism has recognisable symptoms, including inability to stop drinking, the need to drink more for the same effect, craving alcohol above anything else.  If the interval between drinks increases or attempts are made to give up drinking suddenly, then stopping alcohol drinking can lead to severe withdrawal symptoms, such as anxiety, sweating, tremor, tachycardia (increased pulse rate) and, nausea.  Esperal tablets 250mg are intended to be used to help break the habit of alcohol dependency by acting as a deterrent to drinking alcohol but they will only be effective as part of a supportive programme and requires commitment and motivation to remain alcohol free.  ^{1, 2}

How does Esperal work?

Esperal tablets 250mg contain disulfiram, a prodrug that is used to treat alcoholism to help break the habit alcohol dependency.  Disulfiram in Esperal tablets 250mg is rapidly metabolised once ingested into diethyldithiocarbamate (DDC) and works by blocking the metabolism of alcohol, which produces an acute sensitivity to alcohol with unpleasant side effects.  Alcohol is normally metabolised in the liver to acetaldehyde by the action of the enzyme alcohol dehydrogenase and acetaldehyde is further metabolised to acetic acid by the action of the enzyme acetaldehyde dehydrogenase.  Disulfiram in Esperal tablets 250mg inhibits the action of acetaldehyde dehydrogenase, resulting in the build-up of acetaldehyde, which is responsible for the unpleasant symptoms associated with excess alcohol consumption and the hangover effect.  It is also thought that Disulfiram in Esperal tablets 250mg has other metabolic effects that contribute to the unpleasant reactions associated with treatment with Esperal tablets 250mg including flushing of the face, a feeling of difficulty in breathing, palpitations, a throbbing headache, nausea and vomiting.  These effects are intended to act as a deterrent to continued alcohol abuse as they continue while drinking alcohol at the same time as taking Esperal tablets 250mg and the unpleasant effects can last for several hours and up to three weeks after Esperal tablets 250mg are no longer taken.  

What does Esperal contain?

Esperal tablets 250mg contains the active ingredient disulfiram, used to treat alcohol dependence. 

Treating alcohol dependence with Esperal

Esperal tablets 250mg contain disulfiram that is used to treat alcohol dependence as part of an integrated programme of counselling and rehabilitation, to help alcoholics remain alcohol free once they have given up drinking alcohol.  Alcohol dependence or alcoholism is an addictive disease that causes dysfunctional behaviour affecting all aspects of life including, relationships and the workplace and has recognisable symptoms, including inability to stop drinking, the need to drink more for the same effect, craving alcohol above anything else and withdrawal symptoms, such as anxiety, sweating, tremor, tachycardia (increased pulse rate), nausea, if the interval between drinks increases or attempts are made to give up drinking.  Disulfiram in Esperal tablets 250mg works by blocking the metabolism of alcohol, which produces unpleasant reactions if alcohol is ingested and include flushing of the face, a feeling of difficulty in breathing, palpitations, a throbbing headache, nausea and vomiting.  These reactions are intended to act as a deterrent to continued alcohol abuse and can last for several hours and up to three weeks after Esperal 250 is no longer taken.  Esperal tablets 250mg should only be used as an aid to giving up alcohol as part of an overall supportive programme.

What are the side effects of Esperal?

The most commonly reported side effects when taking Esperal tablets 250mg include drowsiness, fatigue, numbness, tingling, pain or weakness in hands or feet (peripheral neuritis, polyneuritis), peripheral neuropathy, skin rash, eye pain or tenderness and changes in vision (optic neuritis), mood and changes, jaundice, impotence, headache, stomach upset, bad breath (halitosis), dizziness

When should Esperal not be used?

You should not use Esperal tablets 250mg if you:

• are allergic to disulfiram or any ingredients in Esperal
• are sensitive to other thiuram derivatives used in pesticides and rubber production
• are pregnant or are breastfeeding
• have kidney or liver disease
• have consumed alcohol within 24 hours
• have used any alcohol-containing food, sauces, remedies, tonics, toiletries, perfumes or sprays within the previous 24 hours
• have severe heart disease or heart failure
• have had a stroke or other serious brain disorder
• have a mood or personality disorder
• are taking medicines that interact with Esperal, including phenytoin for seizures, isoniazid for tuberculosis treatment, benzodiazepines like diazepam for anxiety, the antibiotic metronidazole, anticoagulants like warfarin, the sedative paraldehyde.

What medications interact with Esperal?

Several medications interact with Esperal tablets 250mg and should either not be taken while you are taking Esperal or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Esperal: isoniazid for tuberculosis treatment, the antibiotic metronidazole, the sedative paraldehyde
• Drugs that are affected by Esperal: phenytoin for seizures, benzodiazepines like diazepam for anxiety, anticoagulants like warfarin

How should Esperal be taken?

You should begin your treatment with Esperal tablets 250mg only after you have stopped drinking any alcohol for at least 24 hours before the first dose.  You should take your Esperal tablets 250mg dissolved in a quarter glass of water or fruit juice, preferably on waking in the morning, and drink immediately.  If the prescribed dose has a sedative effect, you can take your Esperal tablets 250mg at bedtime.  The dose you take will be reduced after the first few days and then you should continue to take your Esperal tablets 250mg for as long as recommended by your doctor, usually from 6 weeks up to 6 months.

How long should you take Esperal?

You should continue to take your Esperal tablets 250mg for as long as recommended by your doctor, usually from 6 weeks up to 6 months.

Missed dose of Esperal

If you miss a dose of Esperal tablets 250mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Esperal be stored?

You should store your Esperal tablets 250mg below 25°C in a cool dry place. 

References

1. Krampe H, Stawicki S, Wagner T, Bartels C, Aust C, Rüther E, Poser W, Ehrenreich H.  Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome.  Alcohol Clin Exp Res 2506; 30: 86-95.
2. Jørgensen CH, Pedersen B, Tønnesen H. The efficacy of disulfiram for the treatment of alcohol use disorder. Alcohol Clin Exp Res 2011; 35:1749-58