Hi all
Suggestion locally that shared care or generalist GPs might take over prescribing disulfiram after we initiate in the core service, but they are rather hesitat. Does anyone know of this going on in their locality? or perhaps even non-medical prescribing of disulfiram?

Look forward to hearing from you

(Please excuse delay in replying as i will be going away for a week this evening)

Susi,
We have a patient on Antabuse prescribed by the GP, we don't have a breathalyser so I advised against it.
It's also of note that Naltrexone should only be initiated in specialist clinics according to the BNF. I did ask them why.
I cannot see a reason why stable patient's need to be under a specialist service for this. If there is a way to get back quickly if pt relapses of course.

I haven't had any of my patients prescribed disulfiram for many years. Do people generally take it for very long? i have had several dry and lapsing alcoholics who keep coming back for acamprosate, so must be finding that helpful.

I do have a breathalyser, and find it occasionally useful, sometimes more as an encouragement to honest discussion rather than for actual use, (if you blew into this breathalyser, what would it tell me?)but surely people stop taking their disulfiram before they re-start drinking, don't they?

If a patient wanted to keep taking disulfiram, and had been on it for say 3/12 under secondary care,and was keen to continue, i would be happy to take over as long as accompanied by a clear care guideline,and treatment plan such as I would expect for any unusual medication coming out of secondary care. Is it expensive? I'll have to check.

My 2005 BNF that I have at home tells me they are £26.28 for 50 tablets.

It has always scared me a bit, becuase of fears about mouthwash, after shave and cough lintus triggering the reaction. I suppose if someone really wants to take it. "GP Notebook " has varoius warning and cautions:
"disulfiram (Antabuse) - functioning as a deterrent through fear of possible reaction with alcohol - if a patient takes alcohol then a systemic reaction may occur with throbbing headache, facial flushing, nausea, vomiting and palpitations"


"before prescribing disulfiram, patients should be warned that the severity of the reaction is unpredictable. Occasionally a reaction may be triggered by the small amount of alcohol in preparations such as cough linctuses

hepatoxicity and psychotic reactions are rare adverse effects to disulfiram treatment
elevated liver function tests - hepatotoxicity is a rare adverse effect to disulfiram treatment; liver function tests should be checked before commencement of and at regular intervals throughout treatment - disulfiram treatment should be witheld if liver enzymes are elevated ten or more times than normal (2)


disulfiram is contraindicated during pregnancy and in patients with a psychosis; also contraindicated if there is an established hypersensitivity
disulfiram should be used with caution in patients with diabetes, epilepsy and hypercholesterolaemia (1)
disulfiram is also contraindicated in patients with seriously impaired cardiac, respiratory, hepatic or cerebral function"

http://www.gpnotebook.co.uk/simplepage.cfm?ID=-14159708...inkID=59777&cook=yes

So i'd want the 2ndry care prescribers to have performed both initial and monitoring liver function tests before asking me to continue prescribing.I think i'd generally prefer to be handing out "contingency management coupons".

I've always recommended to shared care GPs that they can continue script of antabuse on those started by the drug service and not had any problems. the evidence though for either antabuse or acamprosate is not great - reduces mean no. of drinking days per year. But high relapse rates for both so really tend to be good for "respite" but not for long-term abstinence

I a previous treatment service I worked in we used Antabuse quite a bit.

This was always prescribed by the GP on our reccomendation following detox.

We monitored it closely i/c random breathalysers but mainly relied on the clients signed consent form which laid out clearly the consequenses of taking ANY alcohol while on this medication.

Part of the consent form was a check list so that GP could see there were no immedialtely obvious contra-indications and they were quite happy to prescribe..

I still have a copy if anyone wants me to send it on - bill-anne@tiscali.co.uk

Thanks to all for help with this. I have a meeting with the LMC soon (scary!) - will be very helpful