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Biomedical subjects

J E Peachey

Publications and source records attributed to J E Peachey.

At least 19 recordsLinked to original sources
PubMed1992

The use of calcium carbimide in relapse prevention counselling: results of a randomized controlled trial.

The effect of combining relapse prevention counselling with use of an alcohol-sensitizing drug was examined. Fifty-six alcoholic subjects who participated in a clinical trial of the short-acting alcohol sensitizing drug, citrated calcium carbimide, were randomly assigned to: (i) a Physician Advice condition in which subjects took the drug within a context designed to reinforce the medical management of their drinking problem; and (ii) a Relapse Prevention condition in which subjects were instructed to pair use of the drug with planned entry into high risk drinking situations and to gradually reduce reliance on the drug by developing alternative coping behaviour patterns. As predicted, subjects receiving carbimide in conjunction with relapse prevention counselling showed significant growth in internal attribution for change; whereas those receiving carbimide under more traditional medical management showed no movement toward internality. On measurement of alcohol consumption at 6, 12 and 18 months follow-up, there was some indication of superior maintenance of treatment gains at 18 months post-treatment for subjects who had received relapse prevention counselling, although the effect did not reach a conventional level of significance (F = 2.82; P less than 0.06). The findings are interpreted as consistent with a cognitive social-learning analysis of the maintenance of behaviour change.

Adult↗
PubMed1989

Calcium carbimide in alcoholism treatment. Part 2: Medical findings of a short-term, placebo-controlled, double-blind clinical trial.

Drug-induced toxicity in chronic alcoholics who participated in a 4-month placebo (Pl)--controlled clinical trial of the efficacy of calcium carbimide (CC) is reported. Daily monitoring of patients' compliance indicated that 85% of study medications were taken, and very little drinking took place during the study. Patients did not report more symptoms or experience more medical problems during CC administration than during placebo administration. There was no evidence of hepatotoxicity, or behavioural toxicity. Mean white blood cell count was slightly increased during CC treatment, and returned to baseline values when CC was stopped. Thyroid function was not affected by CC in patients with normal pretreatment function. However one patient with pretreatment reduced thyroid function became hypothyroid after CC administration, which indicates a need for systematic monitoring. We conclude that CC is safe for use in alcoholics with normal thyroid function, and may be the preferred alcohol-sensitizing drug in some situations.

Administration, Oral↗
PubMed1989

Calcium carbimide in alcoholism treatment. Part 1: A placebo-controlled, double-blind clinical trial of short-term efficacy.

A randomized, double-blind, placebo-controlled single cross-over study of the alcohol sensitizing drug, calcium carbimide (CC), was conducted in 128 patients with alcohol dependence. Seventy-one (55%) completed the 4-month study. Patients reported drinking and pill-taking behaviour, and submitted urines (for analysis of alcohol and the tablet marker riboflavin) on 97%, and 91% of treatment days, respectively. All of the 69 analyzable completers were abstinent on at least 85% of days, and 58% (40) were alcohol-free during the study. Medications were taken on at least 85% of days. Symptoms and adverse clinical findings were not increased in frequency during CC, compared to placebo. Seventy-eight per cent of the patients believed they had received CC throughout the study, suggesting that CC exerts a strong psychological deterrent effect. Alcohol consumption was significantly reduced to the same extent with CC and placebo, compared to pre-treatment levels.

Adult↗
PubMed1987

Clinical observations of agonist-antagonist analgesic dependence.

The agonist-antagonist opioids are clinically effective analgesics with generally low abuse potential. Four agonist-antagonists are currently available for use as analgesics. Pentazocine, butorphanol and nalbuphine produce morphine-like effects in low doses and, to varying degrees, dysphoric effects as the dose is increased. Buprenorphine, an antagonist opioid of slow onset but long duration of action, produces morphine agonist effects at lower doses, and as the dose is increased, antagonist effects with minimal or no dysphoria. Clinical experience with pentazocine indicates that abuse is possible and consists of two main types: misuse (and abuse) of the drug alone by patients during treatment for pain and, abuse of the drug, often taken together with other psychoactive agents, as a substitute for the preferred drug of abuse. Few reports of abuse have appeared for butorphanol, nalbuphine and buprenorphine; however, considerable care is recommended in their use in patients, especially where there is the possibility for abuse as might occur in patients who require long-term treatment, with a history of drug abuse, and where the drug is easily obtained.

Analgesics, Opioid↗
PubMed1986

Monitoring drinking behavior with the alcohol dipstick during treatment.

The present communication is the first report on the clinical use of the alcohol dipstick to continuously monitor alcoholics' drinking during treatment. Daily urine samples from 34 alcoholics were tested for alcohol by the clinical staff using the alcohol dipstick. The patients also provided self-reports of drinking daily. Patients' compliance for submitting urine samples and for completing daily monitoring sheets (DMS) was 93 and 95%, respectively. Over 75% of the patients drank on at least one occasion; about half of these patients denied drinking detected by the urine tests. Drinking was confirmed by both methods in 39% of the patients who drank, and by the urine testing alone in 54%. The patients in treatment for less than 2 months were abstinent on 85% of the days compared to 98% for those in treatment for 6 months or longer. Seventy-two percent of all alcohol-positive urine samples were submitted by patients on days when they denied drinking. Monitoring of patients' drinking was useful in their clinical management. The alcohol dipstick was a simple, inexpensive, and rapid alcohol measuring procedure that could be used by the clinical staff in the treatment setting.

Adult↗
PubMed1984

The role of drugs in the treatment of alcoholism.

Many drugs are used in alcoholism treatment with the aim of reducing alcohol consumption and correcting alcohol-related psychosocial problems that lead to excessive drinking or result from it. Alcohol-sensitising drugs are used to reduce alcohol consumption with the expectation that improvement in other problem areas will follow. Drugs that share sedative-hypnotic actions with and cross-dependence to alcohol are often used during acute alcohol withdrawal reactions for symptomatic relief, to prevent major withdrawal symptoms, and to prevent and treat seizures. Alcohol abuse may be a form of self-medication, and treatment of an underlying psychiatric disorder, such as depression (with antidepressants), anxiety (with anxiolytics) or psychosis (with antipsychotics), is expected to reduce alcohol consumption. Pretreatment medical and psychiatric assessment of the patient is necessary to ensure that the drug therapy is appropriate to the patient's therapeutic goals and medical/psychological status. Use of the drug must be systematic and carefully monitored; the duration of treatment is determined individually for each patient on the basis of the response to the treatment as well by the development of adverse clinical effects. Ideally, the drug therapy allows the patient to establish resources necessary for continued abstinence after the drug treatment is stopped.

Acetaldehyde↗
PubMed1984

Pharmacologic treatment of chronic alcoholism.

Of the many drug therapies mentioned in this review, only the alcohol-sensitizing drugs have current therapeutic applications in primary alcoholics. When alcohol abuse occurs in association with anxiety, depression, or schizophrenia, treatment with the anxiolytic, antidepressant, and neuroleptic drugs, respectively, may facilitate the alcoholic's ability to participate in other programs. Patients should receive drugs that are appropriate to treatment goals as well as to their psychosocial status. Even if a drug therapy is shown to be efficacious under controlled experimental conditions, its effectiveness may be compromised by a large number of factors that include poor compliance by the patient, a lack of a treatment strategy, or failure to optimize the treatment conditions. New pharmacotherapies with actions directed at central neurochemical pathways mediating alcohol consumption are urgently needed. However, even if such agents become available, they too will only be adjuncts to behavioral and social therapies directed at stabilizing all aspects of the alcoholic's life.

Acetaldehyde↗
PubMed1983

A placebo-controlled double-blind comparative clinical study of the disulfiram- and calcium carbimide-acetaldehyde mediated ethanol reactions in social drinkers.

Treatment for 2 days with disulfiram (3.5 mg/kg once daily) and calcium carbimide (0.7 mg/kg twice daily) in social drinkers produced, as compared to controls, similar blood ethanol values, 2- to 3-fold increases in blood acetaldehyde, respectively, and increased heart rate, pulse pressure, skin temperature, and flushing following 0.15 g/kg of ethanol taken 12 hr after the last drug administration. Peak blood acetaldehyde concentration was greater for calcium carbimide compared to disulfiram (p less than 0.05) and subjects treated with calcium carbimide experienced greater discomfort compared to disulfiram due to palpitations and shortness of breath, and they reported less intention to drink during the reaction. However, neither drug produced sufficient aversion to curtail further drinking totally. With repeated drinks, there was an overall reduction of blood acetaldehyde concentration for calcium carbimide of 85% and for disulfiram of 35%. These data may provide a biochemical basis for the claims of certain alcoholics that they can drink to "burn off" the effects of these drugs.

Acetaldehyde↗
PubMed1981

Cardiovascular changes during the calcium carbimide-ethanol interaction.

Potentially serious cardiovascular changes occur in alcoholics as a results of carbimide-ethanol reactions (CERs). Hypotension and tachycardia often occur when blood acetaldehyde levels increase. Hypotension with bradycardia can also occur secondary to vagal stimulation, the results of retching or vomiting. Conservative procedures (e.g., modified Trendelenburg's position) are usually effective in reversing the hypotension but in severe reactions active treatment (intravenous fluids, O2, and drugs) may be indicated. Three case reports are presented to illustrate cardiovascular responses during CERs; for comparison, changes for one subject during a disulfiram reaction are also presented. Caution is recommended in screening alcoholics before treatment with carbimide or disulfiram so as to rule out cardiovascular, hepatic, or renal diseases.

Acetaldehyde↗
PubMed1981

A comparative review of the pharmacological and toxicological properties of disulfiram and calcium carbimide.

Disulfiram and calcium carbimide are widely used alcohol deterrents. Their safe use, however, requires a knowledge of their pharmacology, toxicity, and interactions with alcohol and other drugs. The absorption, metabolism, and elimination of these compounds are described, and elimination of these compounds are described, as is the mechanism of their reaction with ethanol. The effects and limitations of the interaction between ethanol and disulfiram and calcium carbimide are discussed. Four areas of concern regarding toxicity are discussed, including medical complications of the reactions with alcohol, toxicity associated with repeated doses of disulfiram or calcium carbimide, possible interactions with other drugs, and acetaldehyde-induce hepatotoxicity and cardiotoxicity.

Acetaldehyde↗