• Chronic alcoholism in patients who require or desire an enforced state of sobriety, which may allow for additional supportive and psychotherapeutic treatment.

Contraindicated in:

• Hypersensitivity to disulfiram or other thiurams (including those used in rubber vulcanization and pesticides)
• Significant cardiovascular disease
• Psychosis
• Concurrent or recent use of metronidazole, paraldehyde, alcohol or alcohol-containing products
• Lactation: Lactation.

Use Cautiously in:

• Diabetes
• Hyperthyroidism
• Epilepsy
• Cerebral damage
• Hepatic or renal impairment
• OB: Safety not established in pregnancy
• Pedi: Safety and effectiveness not established in children.

Derm: acneiform eruptions, allergic dermatitis.

EENT: optic neuritis.

GI: HEPATOTOXICITY, metallic/garlic-like taste.

GU: erectile dysfunction.

Neuro: drowsiness, fatigue, headache, peripheral neuritis/neuropathy, polyneuritis, psychoses.

Drug-Drug:

• The alcohol-disulfiram interaction is the mainstay of therapy; concurrent use results in severe alcohol intolerance resulting in flushing, ↑ respiration, pulse and cardiac output.
• Concurrent use with isoniazid may result in unsteady gait and behavior changes (↓ disulfiram dose or discontinue).
• Concurrent use with metronidazole↑ risk of psychoses or confusion (one or both drugs may need to be discontinued).
• ↓metabolism and may ↑ CNS depression from some benzodiazepines; use those which are metabolized by other pathways (temazepam, oxazepam, lorazepam).
• ↓metabolism and may ↑ CNS depression from chlorzoxazone (dose ↓ may be necessary).
• May ↑ CNS and cardiac stimulation from caffeine.
• May ↑ risk of adverse cardiac reactions from cocaine.
• May ↑ levels and risk of toxicity from phenytoin and theophylline; monitoring is recommended.
• May ↑ levels and risk of organic brain syndrome from tricyclic antidepressants.

(Generic available)

• Tablets: 250 mg; 500 mg;

• PO (Adults): 500 mg/day for 1–2 wk, then 250 mg/day (up to 500 mg/day).

Antabuse

• Inhibits the enzyme aldehyde dehydrogenase, this results in toxic accumulation of acetaldehyde one of the initial breakdown products of alcohol. The alcohol-disulfiram reaction is unpleasant and discourages alcohol ingestion.

• Alcohol abstinence.

Therapeutic Classification: alcohol abuse therapy adjuncts

Pharmacologic Classification: enzyme inhibitors

Absorption: Slowly absorbed from the GI tract.

Distribution: Unknown.

Metabolism/Excretion: Rapidly and extensively metabolized; some hepatic metabolism. Metabolites a slowly eliminated by the kidneys.

Half-life: Unknown.

• Inform patient of purpose of disulfiram and the consequences of drinking alcohol during therapy.
• May cause drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Caution patient not to take alcohol or any medication containing alcohol during therapy or for 14 days following therapy; may cause a disulfiram-reaction (blurred vision, chest pain, confusion, dizziness or fainting, fast or pounding heartbeat, flushed or redness of face, increase sweating, nausea, vomiting, throbbing headache, trouble breathing, severe weakness, seizures, unconsciousness, heart attack death). Reaction may persist from 30 min to several hours. Advise patient to check all medications for the presence of alcohol.
• Advise patient to consult health care professional prior to taking other CNS depressants.
• Advise patient to notify health care professional of signs of hepatotoxicity (yellow eyes or skin, darkening or urine, light-gray colored stools, severe stomach pain) occur.

di-SUL-fir-am