The use of cyanamide in the treatment of patients with alcoholism

30.03.2020

Drinking alcohol causes not only physical but also psychological dependence. Alcoholism has long been called a disease in which a person himself cannot, and often does not want, to cope with a bad habit.

But today there are effective, sometimes radical, measures and drugs that help cope with a difficult problem. Esperal is considered one of the most effective remedies in the fight against alcoholism.

Content:

1. What is Esperal used for?
2. Reaction to alcohol after Esperal
3. Are there any contraindications to treatment with Esperal?
4. Does Esperal cure alcoholism?

In the practice of treating chronic alcohol dependence, the drug Esperal has been successfully used for quite a long time. Its history began in the middle of the last century and, like many things in medicine, it was discovered almost by accident. It’s just that one scientist noticed that Danish workers working in vulcanization shops cannot tolerate alcohol. It turned out that they were all in contact with disulfiram. This substance caused attacks of nausea, dizziness, and pressure changes after drinking alcohol. Soon Dr. Jacobsen experienced the same symptoms. He decided to study for himself the safety of the active substance of modern Esperal, after which he went to lunch, drank alcohol while eating and felt unwell.

Features of treatment

Treatment of the patient should only take place under the supervision of a physician, since it is impossible to predict how strong the reaction will be during testing. There are times when everything is very difficult and there is a need for medical care. Also, if the symptoms do not go away for more than an hour and a half, then doctors will have to intervene here too.

Therapy with Esperal is carried out only with the consent of the patient. They tell him what sensations may appear after drinking vodka or another alcoholic drink. The patient should be aware of the consequences.

Before starting treatment with Esperal, you must either voluntarily abstain from alcohol for 3-4 days, or, if this is not possible, put on drips for detoxification.

What is Esperal used for?

Synthesized disulfiram began to be used for medical purposes in the 20th century as a cure for alcoholism. The action of this drug is based on blocking liver enzymes that neutralize ethanol in the blood. In this case, the decomposition of alcohol is stopped at the stage of formation of acetaldehyde (acetaldehyde). This substance is poisonous to the body. Its accumulation in the blood causes symptoms of poisoning.

Having received the commercial name "Esperal", the drug is administered orally in the form of tablets or used for drug coding. Today it is recognized as one of the most effective methods and methods for preventing breakdowns in alcohol addiction.

On the pharmaceutical market you can find many analogues of this medicine - Torpedo, Lidevin, Teturam, Aquilong, Algominal, Disulfiram.

Taking the tablet form begins with small doses. All appointments are made by a narcologist. Strict monitoring of regularity of intake and compliance with dosage is required. Unfortunately, this cannot always be provided. Especially if a person refuses to be hospitalized in a specialized hospital or private clinic. In this case, the coding procedure is a good solution. It has its advantages, because now the addict does not have to follow a strict schedule for taking pills, and there is no need for strict medical supervision.

Medication coding Esperal involves administering the drug intramuscularly and intravenously

, as well as sewing a capsule with the drug under the shoulder blade or into the buttock. In the latter case, a special pharmaceutical form (implantation tablet) will allow the active substance to be gradually released into the patient’s blood.

And in order to create a negative attitude towards alcohol, a provocation is carried out under the control of narcologists. This is a kind of disulfiram test, during which, after coding, the patient is given a small amount of ethyl alcohol. It provokes the development of poisoning and, as a result, the formation of a negative attitude towards alcohol. In the case of such a controlled provocation, Esperal does not cause any significant harm to the human body. Symptoms of the disulfiram-ethanol reaction in the form of weakness, nausea, vomiting, redness of the skin of the face and a feeling of a rush of blood to it, a decrease in blood pressure and tachycardia, do not appear strongly, since the administered dose of alcohol is obviously small. But at the same time, a conditioned reflex reaction is developed with the formation of aversion to the taste and smell of alcohol.

How does Esperal work for alcoholism?

When alcohol enters our body, the liver produces special enzymes that break down alcohol. Thus, alcohol is completely eliminated from the body naturally in a short time, which avoids intoxication. Esperal blocks the production of enzymes responsible for the breakdown of alcohol. Esperal coding leads to the fact that even a small dose of alcohol causes severe poisoning. The person experiences extremely unpleasant physical sensations, as well as panic fear for his own life. This fear leads to a complete cessation of drinking alcohol.

Reaction to alcohol after Esperal

If someone coded with this drug, or taking it orally, drinks alcohol, then he is guaranteed to experience unpleasant sensations.

Alcohol after Esperal provokes primarily:

• severe headache;
• attacks of nausea;
• severe, uncontrollable vomiting.

In cases where a person, by mistake, or not believing in the effect of the drug, drinks a lot of alcohol after Esperal, he may experience the development of:

• low or high blood pressure;
• feelings of lightheadedness, weakness;
• joining tachycardia;
• the appearance of shortness of breath;
• redness of the skin.

In severe cases, with continued drinking, epileptic seizures and respiratory arrest develop. The endocrine and excretory systems may be affected, and the pancreas and kidneys will begin to suffer. Joint pain and diarrhea will join this already unpleasant condition.

From the situation described above, which hardly anyone wants to get into on their own and of their own free will, it is clear that alcohol is prohibited after Esperal. A person taking it, or receiving a disulfiram implant, should not consume alcohol in any form or dose, even low-alcohol cocktails or “harmless” beer.

Doctors warn patients that after the drug coding procedure, it is important to check all their drinks and food for the presence of ethyl alcohol. A banal cake soaked in cognac, candy with liqueur, or a compote that has gone on a spree can cause serious consequences.

Particular attention should be paid to the patient and his relatives with alcohol tinctures from the pharmacy.

Such dosage forms are also contraindicated for use.

If you still drink alcohol while experiencing Esperal coding, you must seek emergency medical help for detoxification.

Important!
Anyone who allows himself to drink “under code” is not going to fight alcohol addiction. He did this even under pain of severe physical suffering. Of course, he needs the help of a narcologist to sober up and set a new code. But in most cases, such a person cannot do without the help of a psychotherapist and step-by-step rehabilitation programs.

The use of cyanamide in the treatment of patients with alcoholism

One of the directions in the treatment of patients with alcoholism is the use of drugs that cause intolerance to any alcohol-containing drinks. The main principle of treatment in these cases is to eliminate the possibility of drinking alcohol for a long period. With many months of forced abstinence from alcohol, the pathological desire for intoxication decreases or completely disappears, and in some cases an aversion to the sight and smell of alcohol appears. During the period of abstinence from alcohol, psychotherapy is carried out, aimed at changing the patient’s attitude towards the consumption of alcoholic beverages, achieving a critical attitude towards drunkenness and awareness of the need for absolute abstinence from any alcoholic beverages. The effectiveness of psychotherapeutic influence increases when the patient knows that drinking alcohol is impossible due to the immediate occurrence of a severe, subjectively difficult to bear condition.

According to the literature (F. G. Mukharlyamova, 1986; M. Lukomskaya, 1997), at least 10% of people who turn to therapists in connection with somatic diseases, as well as those hospitalized in various therapeutic and surgical hospitals, are alcoholic (suffer from dependence on alcohol). If anti-alcohol therapy is not carried out and alcohol abuse continues, treatment of the somatic disease is ineffective or ineffective. This applies equally to diseases of different systems: cardiovascular (cardiomyopathies, hypertension, atherosclerosis), respiratory (chronic bronchitis, pneumonia, tuberculosis), digestive (acute and chronic gastritis, liver pathology, peptic ulcers, pancreatitis), endocrine and any other pathology of internal organs.

Anti-alcohol treatment is carried out by a psychiatrist-narcologist, but it is permissible, subject to certain conditions (special training of doctors and medical personnel, consultation with a narcologist), the use of certain methods of therapy for alcohol dependence in a somatic hospital (therapeutic, TB, surgical) or clinic.

One of these methods is to carry out courses of treatment with the drug Colme, which causes alcohol intolerance.

Colme (cyanamide) was synthesized in 1953 by Fergusson and was successfully used in medical practice abroad, and since the early 1960s of the last century in the USSR (B. M. Segal, Y. K. Averbakh, 1961, 1964).

Colme is a drug that causes sensitization to alcohol (ethanol). Just like disulfiram (Teturam, Antabuse, Esperal), Colme inhibits the activity of acetaldehyde dehydrogenase, an enzyme involved in the oxidative metabolism of ethanol. As a result, the conversion of acetaldehyde to acetic acid is delayed. Accumulated acetaldehyde has a toxic effect. This effect from Colme is achieved only when drinking alcoholic beverages. Using the drug without drinking alcohol does not cause toxic effects.

The sensitizing effect of Colme appears 45-60 minutes after its administration and persists for 12 hours at a dose of 50 mg and about 24 hours at a dose of 100 mg. According to some reports, intolerance to alcohol occurs 2.5-3 hours after taking Colme.

If you do not drink alcohol, Colme is well tolerated and, as a rule, does not cause side effects. The less toxic effect of the drug compared to Teturam is explained by the fact that it requires a smaller dose (50-100 mg per day) and has a weaker effect on the activity of dopamine beta-hydroxylase. Side effects include drowsiness, muscle hypotension, tinnitus, and with long-term use, hematopoietic disorders are possible. Daytime sleepiness can be easily avoided if you take the drug in the evening, reduce daily doses, and also include injections of vitamin B1 (2-3 ml of a 5% solution) into therapy.

Colme is available in liquid form (6% solution, 1 ml contains 60 mg of the drug). Colme's solution is colorless, has no taste, and is taken in the form of drops (12-25 drops 2 times a day).

The liquid form, unlike tablets, does not allow some patients to spit out the medicine, and it is easier for others to control the drug intake.

Treatment for Colme is carried out in two options. The first involves taking Colme in therapeutic dosages (50-75 mg per day) for several days and then conducting so-called cyanamide-alcohol tests 2-3 times a week. To do this, patients are given 20-40 ml of alcohol (40% vodka) in the presence of a doctor. Repeated occurrence of the reaction conditionally causes an aversion to the taste and smell of alcohol, a decrease or suppression of the desire for alcohol. This technique is not currently used, since its effectiveness does not exceed that when using another option that does not involve repeated cyanamide-alcohol tests.

The second technique consists of long-term (daily) administration of Colme in therapeutic doses, which allows one to achieve “metabolic blockade” - the inability to drink alcohol. With prolonged abstinence from alcohol, the desire for intoxication fades or disappears completely. In some cases, a single cyanamide alcohol test is performed. To do this, a few days after daily intake of 50-100 mg of Colma, the patient is asked to drink 20-40 ml of 40% vodka on an empty stomach. 2-7 minutes after consuming alcohol, sharp hyperemia of the skin, tachycardia (up to 120-140 beats/min), tachypnea, a feeling of difficulty breathing, a slight increase, and then a decrease in blood pressure (both systolic and diastolic) by 20- 30 mmHg Art. Patients complain of a feeling of a rush to the head, a throbbing headache, and discomfort in the head and in the heart area. Hyperemia is observed in the face (except for the nose), ears, neck, upper half of the body, back, and in certain areas of the skin of the arms and legs. At the maximum manifestation of the reaction, which is achieved after 15–20 minutes, cyanosis occurs. The reaction ends on its own after 1 hour. Sometimes, after this period, severe weakness, pulse lability, headache, shortness of breath, and instability of blood pressure are observed.

Indicators of the need to stop the cyanamide-alcohol reaction are sudden shortness of breath, a significant drop in blood pressure (systolic - 80 mm Hg, diastolic - below 20 mm Hg), cyanosis of the skin, and very poor health.

Collaptoid states are extremely rare. In these cases, the patient is given a horizontal position (it is desirable that the head is lower than the legs), drugs that increase blood pressure are administered, and methylene blue is administered intravenously. Inhalation of oxygen is indicated. In general, cyanamide-alcohol reactions proceed more easily than teturam-alcohol reactions.

In the case of a severe cyanamide-alcohol reaction, patients should remain in bed for several hours (usually until weakness disappears and blood pressure normalizes). When conducting cyanamide-alcohol tests, no occurrence of convulsive seizures or psychoses, which are sometimes observed with teturamide-alcohol reactions, was observed.

Regardless of the methods of use of Colme, before starting treatment, it is necessary to inform the patient and his relatives in detail about the effect of the drug. All patients give a written commitment to completely stop drinking alcohol and indicate that they have been warned about the possibility of complications (even the most severe) if the sobriety regime is violated. This “receipt” has a double meaning. Firstly, the patient is warned about the consequences of drinking alcohol, which in itself reduces the intensity of the desire for intoxication. Secondly, if the patient violates the sobriety regime, the doctor does not bear legal responsibility for this.

During the course of many months of taking Colme (the duration of the course is determined individually and depends primarily on the intensity of the pathological desire for intoxication), psychotherapy is required. It is carried out by a psychiatrist-narcologist, psychotherapist or specially trained psychologist. The patient is constantly reminded that he independently made the decision to be treated with Colme and that the main goal of drug therapy is to rid him of alcohol dependence and improve his physical and mental condition.

During treatment with Colma, it is possible to prescribe other drugs to normalize sleep (various sleeping pills for a short time), eliminate depression (certain antidepressants depending on the form of depression), anxiety (anti-anxiety drugs from the group of diazepines and “minor neuroleptics”), asthenic manifestations (vitamin therapy, nootropics).

Colme can also be used to enhance the teturam-alcohol response. This applies to those cases when the dose of alcohol is quite large (more than 50 ml of vodka), and the teturam-alcohol reaction is very weak. Additional use of 50–100 mg of Colme leads to a severe reaction. In this case, caution must be exercised, especially if there is pathology of the cardiovascular system.

Absolute contraindications for the treatment of Colme are infectious diseases, severe somatic and neurological disorders, including chronic somatic diseases in the acute stage (cardiovascular diseases with symptoms of decompensation, severe pulmonary pathology, cirrhosis of the liver, pancreatitis in the acute stage, insufficiency of liver and kidney function , pathology of the thyroid gland). Contraindications are the presence of organic brain damage with frequent seizures and pronounced personality changes, schizophrenia with symptoms of exacerbation of the disease. Colme should not be prescribed during pregnancy and to persons over 60 years of age.

Relative contraindications are moderately severe pathology of internal organs, residual effects of traumatic brain injury, hypertension in the first stage.

Literature

1. Segal B. M., Averbakh Y. K. Alcoholism and alcoholic psychoses. M., 1963. pp. 289–294.
2. Segal B. M., Averbakh Y. K. Treatment of persons suffering from alcoholism with cyanamide in hospital and out-of-hospital conditions. Instructional and methodological letter. M., 1964. 8 p.
3. Segal B. M. Alcoholism. M.: Medicine, 1967. 578 p.
4. Lukomskaya M. Alcoholism in Russia. M.: Humanitarian, 1997.
5. Mukharlyamova F. G. On the issue of early detection of patients with alcoholism in institutions of the general medical network // Pathogenesis, clinic, therapy of alcoholism and alcoholic psychoses. M., 1986. pp. 200–202.
6. Altshuler V. B., Kravchenko S. L., Rusinov A. V. The drug “Colme” as a means of aversion therapy for patients with alcoholism // Psychiatry and psychopharmacotherapy. 2006. T. 8. No. 1.

A. G. Gofman , Doctor of Medical Sciences, Professor T. A. Kozhinova , Candidate of Medical Sciences I. V. Yashkina , Candidate of Medical Sciences, Research Institute of Psychiatry, Moscow

Are there any contraindications to treatment with Esperal?

Like any other medicine, it has its contraindications.

It should be used with caution in persons over 60 years of age and in the presence of:

• psychoses,
• peptic ulcer of the stomach and duodenum,
• diabetes mellitus;
• decompensated diseases of the cardiovascular system;
• aortic aneurysm;
• acute liver or heart failure;
• glaucoma;
• tuberculosis.

This is why it is important to never give a drug to an addict without a doctor, and certainly not to use it without the patient’s knowledge.

Interesting!
In the medical literature, references have appeared to studies by Israeli and Canadian oncologists confirming the importance of the use of disulfiram as an antitumor agent. Of course, it will not become the main drug in the fight against cancer. But in combination with other methods, in particular chemotherapy, it gives good results, prolonging the life of patients with the metastatic form.

Preparation for the procedure

For implantation to be effective, you need to properly prepare for it.

During the week before coding "Esperal" you must refrain from drinking alcohol. This will allow the body to cleanse itself of ethyl alcohol breakdown products. Otherwise, after administering the drug, the patient will immediately feel unwell.

To determine the body’s readiness for implantation and eliminate contraindications, it is necessary to undergo a full medical examination before the procedure. In addition, before sewing in the Esperal drug, the patient must visit a narcologist and give his written consent to the procedure.

Literature:

1. Methods of psychotherapy for drug addicted patients / I. D. Darensky. — Moscow: Sputnik+ Company, 2007. — 414 p.
2. A manual on narcology for doctors and paramedics of primary medical care / A. A. Churkin, T. V. Klimenko. - Moscow ; Khanty-Mansiysk: Health and Society, 2006 (Cheboksary: ​​IPK Chuvashia). — 173 p.
3. How to get rid of bad habits quickly and without problems: [result 100%] / I. A. Cheryasova. - Moscow: RIPOL classic, 2008. - 191 p.

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Advantages of the method

The main advantages of the technique are the presence of a long-term result in the form of giving up alcohol and convenience, since a person does not need to take medications every day.

The duration of the Esperal file is no more than an hour. It is necessary to understand that this technique does not relieve a person from addiction, but only restrains him. Therefore, an important role in therapy is played by the psychological component, the patient’s positive attitude, and his sincere desire to get rid of alcoholism.

What determines the effectiveness of the procedure?

There are two aspects on which the effectiveness of this manipulation depends:

• motivation - a person must sincerely want to quit drinking and set himself up to overcome all possible difficulties along this difficult path. If the decision to encode was made under pressure from family or friends, then the result will most likely be temporary and after some time a breakdown will occur;
• doctor's qualifications - Esperal should be implanted by a narcologist with experience in conducting such procedures. Doctors of any other specialties will not be able to provide correct and high-quality manipulation.

What should not be consumed during treatment with Esperal?

Taking Esperal imposes serious restrictions on the patient’s diet, about which the doctor must inform him during the consultation. During treatment you should not consume:

• Any alcoholic drinks, even in the smallest doses;
• Any alcohol-based medications;
• Any fermented products (kvass, kefir, yogurt, etc.), as well as products prepared on their basis;
• Confectionery products containing alcohol.

A patient undergoing treatment with Esperal must independently monitor what is on his table. As a rule, a kind of “diet” is broken just during feasts. Having carefully examined the festive table, a person immediately “cuts off” all the bottles of alcohol, but forgets about other things and happily treats himself to sweets and cognac. Of course, he won’t lose consciousness from this, but he will suffer from a headache.

Contraindications. Why you can’t self-medicate

When a person does not drink alcohol, disulfiram is in the body, but does not manifest itself in any way. But

As soon as the patient “breaks”, the consequences will not take long to arrive. Sometimes they can be very serious: in case of loss of consciousness, drop in blood pressure, convulsions and other symptoms of severe poisoning, you should consult a doctor. Even if a person has firmly decided not to drink alcohol, the use of Esperal will be contraindicated if he has:

• Coronary heart disease; previous heart attack;
• Diabetes mellitus;
• Inflammation of the heart muscle;
• Nervous system disorders;
• In women, on top of everything else, pregnancy.

The decision to prescribe Esperal for each individual patient is made by the doctor after conducting a comprehensive examination. Unfortunately, some people, wanting to help their relatives (or vice versa, tired of their alcoholism), mix Esperal into their food. This is very dangerous, because if you overdose and the person then drinks “as usual,” the consequences can be very dire.

What you need to be prepared for

Let's return to the beginning of our article and consider in more detail the mechanism of action of Esperal on the human body. What will happen to an alcoholic if he drinks a couple of glasses of vodka out of habit?

When drinking a small dose of alcohol, a person will be very lucky. He will “just” experience a multi-day hangover with severe headaches, constant vomiting and a general loss of energy. Why is it believed that the patient got off easy? Because if an alcoholic drinks his “usual” amount, the body, deprived of protection, may react:

• Drop in blood pressure and loss of consciousness;
• Stopping breathing;
• Convulsions and paralysis of limbs;
• Severe pain in the chest, including heart attack;
• In especially severe cases - death.