Disulfiram
Disulfiram (Antabuse)
Disulfiram
(dye- SUL-fih-ram) Antabuse (Rx)

Classification: Treatment of alcoholism

Action/Kinetics: Produces severe hypersensitivity to alcohol. Inhibits liver enzymes that participate in the normal degradation of alcohol. This results in accumulation of acetaldehyde in the blood. High levels of acetaldehyde produce a series of symptoms referred to as the disulfiram-alcohol reaction or syndrome. The specific symptoms are listed under Side Effects. The symptoms vary individually, are dose-dependent with respect to both alcohol and disulfiram, and persist for periods ranging from 30 min to several hours. A single dose of disulfiram may be effective for 1-2 weeks. Onset: May be delayed up to 12 hr because disulfiram is initially localized in fat stores.

Uses: To prevent further ingestion of alcohol in chronic alcoholics. Should be given only to cooperating clients fully aware of the consequences of alcohol ingestion.

Contraindications: Alcohol intoxication. Severe myocardial or occlusive coronary disease. Use of paraldehyde or alcohol-containing products such as cough syrups. If client is exposed to ethylene dibromide.

Special Concerns: Use in pregnancy only if benefits outweigh risks. Use with caution in narcotic addicts or clients with diabetes, goiter, epilepsy, psychosis, hypothyroidism, hepatic cirrhosis, or nephritis.

Side Effects: In the absence of alcohol, the following symptoms have been reported: Drowsiness (most common), headache, restlessness, fatigue, psychoses, peripheral neuropathy, dermatoses, hepatotoxicity, metallic or garlic taste, arthropathy, impotence. In the presence of alcohol, the following symptoms may be manifested. CV: Flushing, chest pain, palpitations, tachycardia, hypotension, syncope, arrhythmias, CV collapse, MI, acute CHF. CNS: Throbbing headaches, vertigo, weakness, uneasiness, confusion, unconsciousness, seizures, death. GI: Nausea, severe vomiting, thirst. Respiratory: Respiratory difficulties, dyspnea, hyperventilation, respiratory depression. Other: Throbbing in head and neck, sweating. In the event of an Antabuse-alcohol interaction, measures should be undertaken to maintain BP and treat shock. Oxygen, antihistamines, ephedrine, and/or vitamin C may also be used.

Drug Interactions: Anticoagulants, oral / Anticoagulant effects by hypoprothrombinemia Barbiturates / Barbiturate effects R/T liver breakdown Chlordiazepoxide, diazepam / Chlordiazepoxide/diazepam effects R/T plasma clearance Isoniazid / Isoniazid side effects (especially CNS) Metronidazole / Acute toxic psychosis or confusional state Paraldehyde / Antabuse-like effects Phenytoin / Phenytoin effects R/T liver breakdown Tricyclic antidepressants / Acute organic brain syndrome

How Supplied: Tablet: 250 mg, 500 mg

Dosage
?Tablets Alcoholism.
Adults, initial (after alcohol-free interval of 12-48 hr): 500 mg/day for 1-2 weeks; maintenance: usual, 250 mg/day (range: 120-500 mg/day). Do not exceed 500 mg/day.