Disulfiram相關之昏迷：病例報告

Disulfiram-Related Coma: A Case Report

國外使用多年的戒酒發泡錠：disulfiram （Antabuse） 在台灣並未取得許可證，目前由衛生署專案核准進口。早在1951 年FDA 即許可disulfiram 用於治療酒精成癮，作為戒酒的嫌惡療法。50 幾年前disulfiram的治療劑量是每日1000 至3000 mg，在此高劑量下引起的disulfiram-ethanol 反應（disulfiram-ethanol reaction；DER）通常很嚴重。甚至沒有酒精的作用下，曾有引起精神病的報告。目前FDA 建議的每日維持劑量從125 mg 到500 mg（最大每日量），平均是250 mg，回顧過去使用如此劑量的安全性與病人的接受度都很好，且能有效預防酒癮病人再喝酒。本文之案例每日僅服用disulfiram 200 mg，但是卻在喝酒後引起嚴重昏迷，經緊急補充體液及維它命B 群等支持性治療，約5 小時後清醒。因國內使用此藥之經驗較少，故提出此個案之經驗分享。

One long-standing pharmacological agent, disulfiram (antabuse), which was approved by FDA for aversive treatment of alcoholism since 1951, has not been permitted to import in Taiwan until recently. More than 50 years ago, the recommended daily dosage of disulfiram is from 1,000 mg to 3,000 mg, and usually cause severe disulfiram-ethanol reaction (DER) under high dosage application. Even without concomitant alcohol use, there were case reports of disulfiram psychosis. The current FDA recommended daily dosage of disulfiram is 125 mg, with 500 mg in maximum and 250 mg on average. Disulfiram under the recommended dosage is usually safe and well accepted, and can effectively prevent the recurrence of alcoholism. In this case report, we presented a case using a daily dosage 200 mg of disulfiram developed a severe coma after drinking alcohol. After supportive treatment with fluids and vitamins B supply, the patient recovered 5 hours later. For the paucity of domestic report in using this medicine, we report this case.