NESMOSET MEDICATED SOAP

Indications

• Alcohol dependence
• Support in alcohol abstinence

Dosage

Children: Refer to the BNF for Children for paediatric dosing recommendations, as specific dosing information is not provided.

Adults: Refer to the BNF for specific adult dosing guidelines, as they may vary based on individual circumstances and treatment goals.

Mechanism of action

Monosulfiram is believed to exert its effects by acting as an inhibitor of aldehyde dehydrogenase, specifically targeting the mitochondrial enzyme. This inhibition prevents the conversion of acetaldehyde to acetic acid, resulting in elevated levels of acetaldehyde when alcohol is ingested. The increased acetaldehyde concentration leads to various adverse effects, including flushing, nausea, and palpitations, which serve as a deterrent to alcohol consumption.

Pharmacodynamics

The pharmacodynamics of monosulfiram relate to its role as an alcohol deterrent. By inhibiting the metabolism of alcohol, it induces unpleasant physiological effects that discourage drinking behavior. The severity of reactions can vary among individuals based on their metabolism and baseline activity of aldehyde dehydrogenase. Monosulfiram does not have significant effects on the central nervous system directly, but rather functions through its metabolic interactions.

Pharmacokinetics

Monosulfiram is absorbed following administration, with its effects lasting as long as the drug is present in the system. The metabolism of monosulfiram is complex and likely involves liver enzymes, with excretion primarily occurring via the urine. The half-life of the drug can vary considerably based on individual metabolic rates and liver function.

Contra-indications

• Hypersensitivity to monosulfiram or any of its components
• Severe liver impairment
• Concurrent use with alcohol

Adverse effects

• Drowsiness
• Headache
• Nausea
• Vomiting
• Diarrhea
• Skin rash
• Hepatotoxicity
• Peripheral neuropathy

Interactions

• Alcohol - can cause disulfiram-like reactions, including flushing, nausea, vomiting, and palpitations
• Warfarin - may increase the anticoagulant effect of warfarin
• Isoniazid - may increase the risk of peripheral neuropathy
• Phenytoin - may alter phenytoin levels

Precautions

• Use with caution in patients with a history of liver disease
• Monitor liver function tests during treatment
• Inform patients about the potential for disulfiram-alcohol reactions
• Caution in patients with a history of seizures

Pregnancy

There is insufficient data on the use of monosulfiram in pregnancy. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether monosulfiram is excreted in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Tablets