Teturam®

Pharmachologic effect:

Antialcoholic

Pharmacodynamics:

The effect of the drug is based on the blockade of acetaldehyde dehydrogenase, which is involved in the metabolism of ethyl alcohol. This leads to an increase in the concentration of the metabolite of ethyl alcohol - acetaldehyde, which causes negative sensations (flushing to the face, nausea, vomiting, tachycardia, lowering blood pressure), which make it extremely unpleasant to drink alcohol after taking Teturam. This leads to a conditioned reflex aversion to the taste and smell of alcoholic beverages.

Pharmacokinetics:

After oral administration the absorption of Teturam from the gastrointestinal tract is from 70 to 90%. It is rapidly metabolized, recovering to dithiocarbamate which itself is excreted as a glucuronconjugate or converted to diethylamine and carbon sulphide, some of which (4-53%) is excreted through the lungs. The maximum therapeutic effect is achieved 12 hours after oral administration and can last for 10-14 days after discontinuation of treatment.

Indications:

treatment and prevention of recurrences of chronic alcoholism;
as a detoxification agent for chronic nickel poisoning.

Contraindications:

hypersensitivity;
thyrotoxicosis;
diseases of the cardiovascular system in the stage of decompensation (including severe cardiosclerosis, atherosclerosis of cerebral vessels, pre- and postinfarction states, aortic aneurysm, coronary insufficiency, arterial hypertension II-III stage);
tuberculosis of the lungs with hemoptysis, bronchial asthma, severe emphysema;
erosive lesions of the gastrointestinal mucosa, peptic ulcer of the stomach and duodenum (in the stage of exacerbation), bleeding from the gastrointestinal tract;
kidney disease, liver failure;
diabetes;
epilepsy, neuromuscular diseases, infectious diseases of the central nervous system, polyneuropathy, neuritis of the auditory and optic nerves;
glaucoma;
malignant tumors;
pregnancy, lactation period.
With caution: cardiovascular diseases in the compensation stage, age over 60, peptic ulcer of the stomach and duodenum (in remission), endarteritis, residual phenomena of cerebral circulation, psychoses against Disulfiram in the history.

Side effects:

Due to the properties of Teturam:
metallic taste in the mouth; unpleasant odor in patients with colostomy (associated with carbon sulphide); rare cases of hepatitis, sometimes found in patients with nickel eczema, not suffering from alcoholism; polyneuritis of the lower extremities, optic nerve neuritis; loss of memory, confusion, asthenia; headache; skin allergic manifestations.
Associated with the combination Teturam -ethyl alcohol:
cases of respiratory insufficiency are described; cardiovascular collapse, rhythm disturbances, angina pectoris, sometimes myocardial infarction as well as neurological disorders; swelling of the brain.
Complications with long-term admission: rarely - psychoses that resemble alcoholic, hepatitis, gastritis; in people suffering from cardiovascular diseases there is a possible thrombosis of the brain vessels, so when complaints about paresthesia in the limbs and face should immediately cancel the drug; aggravation of polyneuritis.

At reception of doses of alcohol over 50-80 ml of vodka on a background of reception of Teturam serious disturbances of cardiovascular and respiratory systems, edemas, cramps develop. In this case, urgently carry out detoxification therapy, inject analeptics, perform symptomatic treatment.

Interaction:

Contraindicated combinations :
Alcohol. The reaction of intolerance (hot flushes, erythema, vomiting, tachycardia). Avoid taking alcohol and medications containing alcohol.

Unwanted combinations:
Isoniazid. Violations of behavior and coordination.
Nitro-5-imidazoles (metronidazole, ordinazole, secnidazole, tinidazole). Delirious disorders, confusion.
Phenytoin. Significant and rapid rise in the level of phenytoin in the plasma with toxic symptoms (suppression of its metabolism).
If the combination can not be avoided - clinical monitoring and control of plasma concentrations of the drug should be carried out during and after treatment with teturum.

Combinations that require caution:
Warfarin (and other oral anticoagulants). The increased effect of oral anticoagulants and the risk of bleeding (reduced biotransformation of warfarin in the liver). It is recommended more frequent monitoring of the concentration of warfarin and correction of the dose of anticoagulants within 8 days after the abolition of teturam.
Theophylline. Teturam inhibits theophylline metabolism. As a result, the dose of theophylline should be adjusted (reduced dosage) depending on the clinical symptoms and the concentration of the drug in the plasma.
Benzodiazepines. Teturam may potentiate the sedative effect of benzodiazepines by inhibiting their oxidative metabolism (especially chlordiazepoxide and diazepam). The dosage of benzodiazepine should be adjusted in accordance with clinical manifestations.
Tricyclic antidepressants. Perhaps an increase in the reaction of alcohol intolerance (especially if patients against the background of taking Teturam, take alcohol).

Dosing and Administration:

Treatment is appointed after careful examination of the patient and warning of the consequences and complications. 150-500 mg 2 times a day according to the individual scheme. After 7-10 days, a teturam-alcohol test is performed (20-30 ml of 40% vodka after taking 500 mg of the drug), with a weak reaction, the dose of alcohol is increased by 10-20 ml (the maximum dose of vodka is 100-120 ml). The test is repeated after 1-2 days in the hospital and 3-5 days after an outpatient treatment with the correction of the doses of alcohol and / or the drug as needed. In the future, a maintenance dose of 150-200 mg / day can be used for 1-3 years.

Overdose:

the combination of Teturam-ethanol can cause depression of consciousness down to coma, cardiovascular collapse, neurological complications. Treatment: symptomatic.

Special instructions: In the case of simultaneous administration with oral anticoagulants - more frequent monitoring of prothrombin content and correction of anticoagulant doses is necessary which is associated with an increased risk of bleeding.

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