Urinary ethylglucuronide assessment in patients treated with disulfiram: a tool to improve verification of abstention and safety.
OBJECTIVE
Disulfiram has been shown to be efficacious and safe in the treatment of alcohol relapse prevention. However, drinking alcohol while taking disulfiram can be harmful because of the resulting alcohol-disulfiram reaction/acetaldehyde reaction. Alcohol consumption of patients receiving a low disulfiram dose or low alcohol consumption in normal disulfiram dose can result in subclinical alcohol-disulfiram reactions. This undermines the learning of alcohol-associated punishment, might increase the risk to raise alcohol consumption, and can result in chronic acetaldehyde exposure, which has carcinogenic, neurotoxic, and cardiotoxic properties. Therefore, the use of an alcohol marker monitoring retrospective alcohol use is tested in this study.


METHODS
A total of 51 patients being treated with supervised disulfiram were unheralded measured for ethylglucuronide (EtG) if they attended at least for 2 weeks in the outpatient treatment program. Ethylglucuronide was measured with liquid chromatography-tandem mass spectrometry analysis (LC-MS/MS). Detection limit was 0.1 mg/L.


RESULTS
Urinary EtG was found positive in 5.9% (3/51) of the patients. Regularly conducted breathalyzer tests had been continuously negative in these patients. Moreover, vegetative withdrawal symptoms had not been found in these patients. Two of the positive EtG tests could be classified as covered relapses, whereas the third remained unclear but showed a negative EtG in a repetition of the test few days later.


CONCLUSIONS
Unheralded urinary EtG monitoring improved verification of abstinence in patients treated with disulfiram, was helpful in detecting covered consumption of alcoholic beverages or hidden alcohol exposition (eg, fruit juice or personal care products), and thereby improved safety by preventing chronic acetaldehyde reaction.
Mutschler
Jochen
J
Department of General and Social Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland. jochen.mutschler@puk.zh.ch
Grosshans
Martin
M
Koopmann
Anne
A
Mann
Karl
K
Kiefer
Falk
F
Hermann
Derik
D
D000328:Adult; D000368:Aged; D000427:Alcohol Deterrents / Q000009:adverse effects / Q000627:therapeutic use*; D000428:Alcohol Drinking / Q000652:urine*; D000437:Alcoholism / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D015415:Biomarkers / Q000737:chemistry / Q000652:urine; D002851:Chromatography, High Pressure Liquid; D023801:Directly Observed Therapy; D004221:Disulfiram / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D016903:Drug Monitoring; D005260:Female; D005965:Glucuronates / Q000737:chemistry / Q000652:urine*; D006801:Humans; D057230:Limit of Detection; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D053719:Tandem Mass Spectrometry; D013695:Temperance
D000427:Alcohol Deterrents; D015415:Biomarkers; D005965:Glucuronates; C093924:ethyl glucuronide; D004221:Disulfiram