Mizo is a drug intended for the treatment of chronic alcoholism. Medicinal drops are an analogue of Colma, and you can buy them only with a doctor's prescription in pharmacies.
If a person decides to drink strong drinks while taking Mizo, he will develop a serious condition in the form of shortness of breath, chest pain, nausea, redness of the skin and fear. This reaction will be deposited in the patient’s mind after drinking alcohol (“if I drink, it will be very bad”). Gradually, a reflex reaction arises in the form of giving up alcohol.
Release form and composition
The drug is available in the form of drops for oral administration, which are a colorless transparent solution with a slight odor of acetic acid (15 ml in brown glass bottles, equipped with a dropper and a screw cap; 4 bottles in a cardboard box and instructions for use).
A drop of Mizo in 1 ml contains:
Active ingredient: cyanamide - 60 mg; auxiliary ingredients: acetic acid - 0.47 mg, sorbic acid - 0.2 mg, sodium acetate trihydrate - 0.47 mg, purified water - up to 1.0 ml.
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Pharmacological properties
Mizo drops are a drug for the treatment of chronic alcoholism, and can also be prescribed for the prevention of relapse. The mechanism of action is due to the blockade of aldehydrogenase, which is involved in ethanol metabolism. Blocking this enzyme leads to an increase in the concentration of ethanol metabolite - acetaldehyde, which causes negative sensations (for example, flushing, nausea, tachycardia, shortness of breath), which make drinking alcohol after taking cyanamide extremely unpleasant. This leads to a conditioned reflex of aversion to the taste and smell of alcoholic beverages.
The sensitizing effect of cyanamide to alcohol appears earlier (after about 45-60 minutes) and lasts shorter (about 12 hours) than disulfiram.
Unlike disulfiram, cyanamide does not have a hypotensive effect and has less intrinsic toxicity. In addition, cyanamide has greater specificity of action: unlike disulfiram, it only blocks aldehydrogenase and does not affect other enzymes, in particular dopamine β-hydroxylase.
Features of the treatment process
Before treatment with Mizo drops, an alcoholic should be familiar with the consequences and dangers of drinking alcohol. It is also necessary to undergo tests to exclude dangerous health consequences. Therefore, it is better to seek help from a narcologist who will advise on contraindications so that taking the drops does not lead to serious threats to a person’s life.
You should not give drops to an alcoholic yourself, especially in the later stages of addiction, as this can lead to undesirable health consequences. Medicines must be prescribed by a doctor, and given that alcoholism is often accompanied by the presence of chronic diseases, this becomes a prerequisite.
Features of using Mizo drops:
- before taking the drug, you must remain sober for 12 hours;
- the course of therapy should last from three months.
Under the supervision of a doctor, you can conduct a test and give a person to drink alcohol so that he feels the negative consequences of drinking. During therapy for more than six months, you should monitor your health status and take tests for thyroid hormones.
Contraindications for use
- respiratory diseases accompanied by decreased functionality;
- severe diseases of the cardiovascular system;
- serious liver disease;
- kidney disease with reduced kidney function;
- During pregnancy and breastfeeding;
- hypersensitivity to the main or auxiliary components of the drug.
Use during pregnancy and breastfeeding
Contraindicated for use during pregnancy and breastfeeding.
Use for liver dysfunction
Contraindicated in severe liver diseases.
Use for renal impairment
Contraindicated in kidney diseases accompanied by impaired function.
How to take medicine correctly
Since Mizo drops are toxic, the drug is prescribed based on diagnostic data. It is difficult to predict how an alcoholic’s body will react to taking alcohol and medication together, so you should not rely on luck in this matter. Drops also have contraindications for use:
- heart disease;
- kidney and liver problems;
- pregnancy and lactation.
Instructions for use
Before taking Mizo, the patient must undergo a thorough examination. The patient should be warned about possible complications and consequences of treatment.
With the help of Mizo drops, wives try to “heal” their husbands. Mothers are trying to cure their children. To do this, without the knowledge of the patient, they mix the medicine into food. This should absolutely not be done!
The drug is taken orally 2 times a day, 12-25 drops (which corresponds to 36-75 mg of cyanamide). The dosage interval is 12 hours. The duration of treatment is individual and is prescribed by a narcologist.
Mizo should not be added to hot food because it is “destroyed” in it.
Precautionary measures
Mizo (Cyanamide) should only be used under medical supervision and with the consent of the patient. The possibility of a reaction to ethanol contained in some medications and foods should be considered.
Treatment with cyanamide should only begin 12 hours after the last drink.
Simultaneous consumption of alcohol can cause severe skin flushing, a sensation of pulsation in the head and neck, nausea, tachycardia, difficulty breathing, weakness, blurred vision, increased sweating, and chest pain. In the most severe cases: vomiting, low blood pressure, difficulty breathing, collapse. Manifestations and their severity depend on the dose of cyanamide and the amount of alcohol consumed. In severe cases, symptomatic therapy is carried out to maintain the functions of the respiratory and cardiovascular systems with the use of antihistamines.
Cyanamide should not be used together with metronidazole, isoniazid, phenytoin and other aldehydrogenase inhibitors - this may increase the reaction to alcohol consumption.
There should be an interval of at least 10 days between taking disulfiram and taking cyanamide.
Cyanamide is incompatible with drugs from the aldehyde group (paraldehyde and chlorine products).
Cyanamide is used with caution in cases where the patient's reaction to the simultaneous use of alcohol may jeopardize his health: with hyperthyroidism, diabetes, epilepsy, cardiovascular diseases, kidney diseases.
If cyanamide is used for a long time, it is recommended to check your thyroid function at least once every 6 months.
The use of cyanamide in the treatment of patients with alcoholism
One of the directions in the treatment of patients with alcoholism is the use of drugs that cause intolerance to any alcohol-containing drinks. The main principle of treatment in these cases is to eliminate the possibility of drinking alcohol for a long period. With many months of forced abstinence from alcohol, the pathological desire for intoxication decreases or completely disappears, and in some cases an aversion to the sight and smell of alcohol appears. During the period of abstinence from alcohol, psychotherapy is carried out, aimed at changing the patient’s attitude towards the consumption of alcoholic beverages, achieving a critical attitude towards drunkenness and awareness of the need for absolute abstinence from any alcoholic beverages. The effectiveness of psychotherapeutic influence increases when the patient knows that drinking alcohol is impossible due to the immediate occurrence of a severe, subjectively difficult to bear condition.
According to the literature (F. G. Mukharlyamova, 1986; M. Lukomskaya, 1997), at least 10% of people who turn to therapists in connection with somatic diseases, as well as those hospitalized in various therapeutic and surgical hospitals, are alcoholic (suffer from dependence on alcohol). If anti-alcohol therapy is not carried out and alcohol abuse continues, treatment of the somatic disease is ineffective or ineffective. This applies equally to diseases of different systems: cardiovascular (cardiomyopathies, hypertension, atherosclerosis), respiratory (chronic bronchitis, pneumonia, tuberculosis), digestive (acute and chronic gastritis, liver pathology, peptic ulcers, pancreatitis), endocrine and any other pathology of internal organs.
Anti-alcohol treatment is carried out by a psychiatrist-narcologist, but it is permissible, subject to certain conditions (special training of doctors and medical personnel, consultation with a narcologist), the use of certain methods of therapy for alcohol dependence in a somatic hospital (therapeutic, TB, surgical) or clinic.
One of these methods is to carry out courses of treatment with the drug Colme, which causes alcohol intolerance.
Colme (cyanamide) was synthesized in 1953 by Fergusson and was successfully used in medical practice abroad, and since the early 1960s of the last century in the USSR (B. M. Segal, Y. K. Averbakh, 1961, 1964).
Colme is a drug that causes sensitization to alcohol (ethanol). Just like disulfiram (Teturam, Antabuse, Esperal), Colme inhibits the activity of acetaldehyde dehydrogenase, an enzyme involved in the oxidative metabolism of ethanol. As a result, the conversion of acetaldehyde to acetic acid is delayed. Accumulated acetaldehyde has a toxic effect. This effect from Colme is achieved only when drinking alcoholic beverages. Using the drug without drinking alcohol does not cause toxic effects.
The sensitizing effect of Colme appears 45-60 minutes after its administration and persists for 12 hours at a dose of 50 mg and about 24 hours at a dose of 100 mg. According to some reports, intolerance to alcohol occurs 2.5-3 hours after taking Colme.
If you do not drink alcohol, Colme is well tolerated and, as a rule, does not cause side effects. The less toxic effect of the drug compared to Teturam is explained by the fact that it requires a smaller dose (50-100 mg per day) and has a weaker effect on the activity of dopamine beta-hydroxylase. Side effects include drowsiness, muscle hypotension, tinnitus, and with long-term use, hematopoietic disorders are possible. Daytime sleepiness can be easily avoided if you take the drug in the evening, reduce daily doses, and also include injections of vitamin B1 (2-3 ml of a 5% solution) into therapy.
Colme is available in liquid form (6% solution, 1 ml contains 60 mg of the drug). Colme's solution is colorless, has no taste, and is taken in the form of drops (12-25 drops 2 times a day).
The liquid form, unlike tablets, does not allow some patients to spit out the medicine, and it is easier for others to control the drug intake.
Treatment for Colme is carried out in two options. The first involves taking Colme in therapeutic dosages (50-75 mg per day) for several days and then conducting so-called cyanamide-alcohol tests 2-3 times a week. To do this, patients are given 20-40 ml of alcohol (40% vodka) in the presence of a doctor. Repeated occurrence of the reaction conditionally causes an aversion to the taste and smell of alcohol, a decrease or suppression of the desire for alcohol. This technique is not currently used, since its effectiveness does not exceed that when using another option that does not involve repeated cyanamide-alcohol tests.
The second technique consists of long-term (daily) administration of Colme in therapeutic doses, which allows one to achieve “metabolic blockade” - the inability to drink alcohol. With prolonged abstinence from alcohol, the desire for intoxication fades or disappears completely. In some cases, a single cyanamide alcohol test is performed. To do this, a few days after daily intake of 50-100 mg of Colma, the patient is asked to drink 20-40 ml of 40% vodka on an empty stomach. 2-7 minutes after consuming alcohol, sharp hyperemia of the skin, tachycardia (up to 120-140 beats/min), tachypnea, a feeling of difficulty breathing, a slight increase, and then a decrease in blood pressure (both systolic and diastolic) by 20- 30 mmHg Art. Patients complain of a feeling of a rush to the head, a throbbing headache, and discomfort in the head and in the heart area. Hyperemia is observed in the face (except for the nose), ears, neck, upper half of the body, back, and in certain areas of the skin of the arms and legs. At the maximum manifestation of the reaction, which is achieved after 15–20 minutes, cyanosis occurs. The reaction ends on its own after 1 hour. Sometimes, after this period, severe weakness, pulse lability, headache, shortness of breath, and instability of blood pressure are observed.
Indicators of the need to stop the cyanamide-alcohol reaction are sudden shortness of breath, a significant drop in blood pressure (systolic - 80 mm Hg, diastolic - below 20 mm Hg), cyanosis of the skin, and very poor health.
Collaptoid states are extremely rare. In these cases, the patient is given a horizontal position (it is desirable that the head is lower than the legs), drugs that increase blood pressure are administered, and methylene blue is administered intravenously. Inhalation of oxygen is indicated. In general, cyanamide-alcohol reactions proceed more easily than teturam-alcohol reactions.
In the case of a severe cyanamide-alcohol reaction, patients should remain in bed for several hours (usually until weakness disappears and blood pressure normalizes). When conducting cyanamide-alcohol tests, no occurrence of convulsive seizures or psychoses, which are sometimes observed with teturamide-alcohol reactions, was observed.
Regardless of the methods of use of Colme, before starting treatment, it is necessary to inform the patient and his relatives in detail about the effect of the drug. All patients give a written commitment to completely stop drinking alcohol and indicate that they have been warned about the possibility of complications (even the most severe) if the sobriety regime is violated. This “receipt” has a double meaning. Firstly, the patient is warned about the consequences of drinking alcohol, which in itself reduces the intensity of the desire for intoxication. Secondly, if the patient violates the sobriety regime, the doctor does not bear legal responsibility for this.
During the course of many months of taking Colme (the duration of the course is determined individually and depends primarily on the intensity of the pathological desire for intoxication), psychotherapy is required. It is carried out by a psychiatrist-narcologist, psychotherapist or specially trained psychologist. The patient is constantly reminded that he independently made the decision to be treated with Colme and that the main goal of drug therapy is to rid him of alcohol dependence and improve his physical and mental condition.
During treatment with Colma, it is possible to prescribe other drugs to normalize sleep (various sleeping pills for a short time), eliminate depression (certain antidepressants depending on the form of depression), anxiety (anti-anxiety drugs from the group of diazepines and “minor neuroleptics”), asthenic manifestations (vitamin therapy, nootropics).
Colme can also be used to enhance the teturam-alcohol response. This applies to those cases when the dose of alcohol is quite large (more than 50 ml of vodka), and the teturam-alcohol reaction is very weak. Additional use of 50–100 mg of Colme leads to a severe reaction. In this case, caution must be exercised, especially if there is pathology of the cardiovascular system.
Absolute contraindications for the treatment of Colme are infectious diseases, severe somatic and neurological disorders, including chronic somatic diseases in the acute stage (cardiovascular diseases with symptoms of decompensation, severe pulmonary pathology, cirrhosis of the liver, pancreatitis in the acute stage, insufficiency of liver and kidney function , pathology of the thyroid gland). Contraindications are the presence of organic brain damage with frequent seizures and pronounced personality changes, schizophrenia with symptoms of exacerbation of the disease. Colme should not be prescribed during pregnancy and to persons over 60 years of age.
Relative contraindications are moderately severe pathology of internal organs, residual effects of traumatic brain injury, hypertension in the first stage.
Literature
- Segal B. M., Averbakh Y. K. Alcoholism and alcoholic psychoses. M., 1963. pp. 289–294.
- Segal B. M., Averbakh Y. K. Treatment of persons suffering from alcoholism with cyanamide in hospital and out-of-hospital conditions. Instructional and methodological letter. M., 1964. 8 p.
- Segal B. M. Alcoholism. M.: Medicine, 1967. 578 p.
- Lukomskaya M. Alcoholism in Russia. M.: Humanitarian, 1997.
- Mukharlyamova F. G. On the issue of early detection of patients with alcoholism in institutions of the general medical network // Pathogenesis, clinic, therapy of alcoholism and alcoholic psychoses. M., 1986. pp. 200–202.
- Altshuler V. B., Kravchenko S. L., Rusinov A. V. The drug “Colme” as a means of aversion therapy for patients with alcoholism // Psychiatry and psychopharmacotherapy. 2006. T. 8. No. 1.
A. G. Gofman , Doctor of Medical Sciences, Professor T. A. Kozhinova , Candidate of Medical Sciences I. V. Yashkina , Candidate of Medical Sciences, Research Institute of Psychiatry, Moscow
