Esperal (disulfiram) is an alcohol antagonist medication, used to help patients quit drinking alcohol. If a patient who has taken Esperal drinks alcohol, negative effects---similar to a severe hangover---will be experienced about 10 minutes later, and last 30 minutes to several hours.

While Esperal is an important and useful tool, on its own it is unlikely to be successful if the patient does not wish to quit. Drive and willpower from a patient are vitally important, and a reliable support network can also be tremendously helpful.

Esperal does not reduce cravings for alcohol; other medications, which do inhibit cravings, may also be administered.

Effects of Esperal

Esperal is a potent medication; a single dose can produce effects for up to two weeks after it's taken. It is also an effective medication; there is no doubt that it works. The importance of drive and willpower---from a patient who truly desires to change---has more to do with continuing to take the medication, rather than a failure of the medication to work.

The duration and severity of effects of Esperal are directly correlated with the amount of alcohol consumed. A patient who has taken Esperal and then drinks alcohol will experience:

• Flushing of skin
• Throbbing in the head and neck
• Nausea and vomiting
• Sweating and thirst
• Blurred vision
• Vertigo
• Confusion
• Heart palpitations
• Labored breathing
• Rapid heartbeat
• Low blood pressure
• Fainting

Some of the above can be dangerous; though rare, some individuals have suffered complete cardiovascular collapse and death when persisting in drinking after taking Esperal. It is, however, very unlikely that the majority of individuals are so determined to drink while ignoring the negative results.

Aside from the immediate effects, one of the ideas behind treatment with Esperal is that, over time, the idea of positive effects from alcohol are eliminated and eventually replaced with negative thoughts. This will take some time to develop, of course, but as Esperal has no tolerance build-up associated with it, the medication can be taken for years if needed.

Standard Administration

Treatment is generally similar in all cases, though there is some variance in the long-term maintenance dose, duration of treatment, and whether or not the patient is being treated in a medical setting or at home. Treatment may be a little more aggressive in a medical setting (such as a rehabilitation clinic). Outside of such a setting, treatment is typically:

• The patient should not have consumed any alcohol for 12 hours prior to taking Esperal.
• Start with 500 mg, taken as a single dose, once per day, for the first one to two weeks.
• After the initial week or two, dosage may be adjusted downward to 250 mg.
• Some patients are able to take 125 mg per day, while others need to stay at 500 mg.
• Do not exceed 500 mg per day.
• Tablets may be swallowed whole, or be split, and can be crushed and mixed in wet food or drinks.
• Treatment may continue for as long as it is beneficial, which often spans months or years.

Patients taking Esperal should be aware that it works on all alcohol. Alcohol is a common ingredient in many over-the-counter medications, such as cough syrups, as well as many foods. These are best avoided; though the small amounts of alcohol are unlikely to produce serious negative effects from Esperal, it may cause mild illness and unpleasantness.

Cravings are much more varied. Some patients will continue to crave alcohol for the remainder of life, though to a lesser degree as time goes on. Others have no powerful cravings after a few months. Other medications can also influence cravings; consult a doctor if cravings are an issue.

Precautions & Side Effects

Before taking Esperal, patients should make sure the prescribing doctor is aware of other major medical conditions that may be present, most notably:

• Heart disease
• Kidney or liver issues
• Diabetes
• Thyroid issues
• Epilepsy
• Mental illness

Some side effects are relatively common, but typically mild and tend to disappear after a few weeks of treatment, including:

• Sexual dysfunction
• Drowsiness
• Unpleasant taste in mouth

Patients who experience the following side effects without drinking alcohol should seek medical attention:

• Blurred vision
• Numbness or tingling, particularly in hands or feet
• Severe stomach pain
• Stomach pain that radiates to the back
• Rash or itching
• Jaundice

Esperal can interact with a wide range of other medications, including over-the-counter medicines, vitamins, supplements, and herbal products, even if they don't contain alcohol. Check with a doctor or pharmacist before taking any other medication with Esperal.