disulfiram

ROUTE	ONSET	PEAK	DURATION
PO	slow	8–10 hr	24 hr

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;
Seizure disorder;
Cerebral damage;
Renal impairment;
Hepatic impairment;
OB: Safety not established in pregnancy;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

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

Interactions ⬆ ⬇

Drug-drug:

The alcohol-disulfiram interaction is the mainstay of therapy; concurrent use results in severe alcohol intolerance, causing flushing and ↑ respiration, pulse, and cardiac output.
Isoniazid may result in unsteady gait and behavior changes; ↓ disulfiram dose or discontinue.
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 that 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.

Route/Dosage ⬆ ⬇

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

Availability ⬆ ⬇

(Generic available)

Tablets: 250 mg; 500 mg

Assessment ⬆ ⬇

Assess patient for recent alcohol use. Do not administer to patients for 12 hr following alcohol ingestion. If a severe disulfiram reaction occurs, administer oxygen, monitor ECG and serum potassium levels, and provide supportive measures.

Lab Test Considerations:

Monitor liver function tests at baseline, after 10–14 days of therapy, and periodically thereafter.
- Monitor CBC and blood chemistry every 6 mo during therapy.
- May ↑ serum cholesterol concentrations.
- May cause ↓ urine VMA concentrations.

Implementation ⬆ ⬇

PO: Administer once daily. May be administered at bedtime to ↓ daytime drowsiness.

Patient/Family Teaching ⬆ ⬇

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, ↑ 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 provider prior to taking other CNS depressants.
Advise patient to notify health care provider of signs of hepatotoxicity (yellow eyes or skin, darkening or urine, light-gray-colored stools, severe stomach pain) occur.
Rep: Advise women of reproductive potential to notify health care provider promptly if pregnancy is planned or suspected and to avoid breastfeeding during therapy.

Evaluation/Desired Outcomes ⬆ ⬇

Maintenance of sobriety in chronic alcoholism.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

42794- Sigmapharm Laboratories, LLC
- 42794-028- Disulfiram
  - 42794-028-08- 30 TABLET in 1 BOTTLE (42794-028-08)

42794- Sigmapharm Laboratories, LLC
- 42794-029- Disulfiram
  - 42794-029-08- 30 TABLET in 1 BOTTLE (42794-029-08)

42973- APICORE PHARMACEUTICALS PRIVATE LIMITED
- 42973-137-
  - 42973-137-00- 50 kg in 1 DRUM (42973-137-00)

42973- APICORE PHARMACEUTICALS PRIVATE LIMITED
- 42973-137-
  - 42973-137-10- 25 kg in 1 DRUM (42973-137-10)

47781- Alvogen Inc.
- 47781-607- Disulfiram
  - 47781-607-30- 30 TABLET in 1 BOTTLE, PLASTIC (47781-607-30)

60429- Golden State Medical Supply, Inc.
- 60429-196- Disulfiram
  - 60429-196-01- 100 TABLET in 1 BOTTLE (60429-196-01)

60429- Golden State Medical Supply, Inc.
- 60429-196- Disulfiram
  - 60429-196-30- 30 TABLET in 1 BOTTLE, PLASTIC (60429-196-30)

62135- Chartwell RX, LLC
- 62135-431- Disulfiram
  - 62135-431-30- 30 TABLET in 1 BOTTLE (62135-431-30)

62135- Chartwell RX, LLC
- 62135-431- Disulfiram
  - 62135-431-90- 90 TABLET in 1 BOTTLE (62135-431-90)

62135- Chartwell RX, LLC
- 62135-432- Disulfiram
  - 62135-432-30- 30 TABLET in 1 BOTTLE (62135-432-30)

62135- Chartwell RX, LLC
- 62135-432- Disulfiram
  - 62135-432-90- 90 TABLET in 1 BOTTLE (62135-432-90)

63629- Bryant Ranch Prepack
- 63629-5466- Disulfiram
  - 63629-5466-1- 90 TABLET in 1 BOTTLE (63629-5466-1)

65571- PolyCarbon Industries, Inc.
- 65571-0005-
  - 65571-0005-2- 1 BAG in 1 DRUM (65571-0005-2) / 30 kg in 1 BAG

72643- Solara Active Pharma Sciences Limited
- 72643-028-
  72643-028-01- 1 kg in 1 DRUM (72643-028-01)

72643- Solara Active Pharma Sciences Limited
- 72643-028-
  72643-028-03- 10 kg in 1 DRUM (72643-028-03)

72643- Solara Active Pharma Sciences Limited
- 72643-028-
  72643-028-04- 25 kg in 1 DRUM (72643-028-04)

72643- Solara Active Pharma Sciences Limited
- 72643-028-
  72643-028-09- 15 kg in 1 DRUM (72643-028-09)

84206- Tianish Laboratories Private Limited
- 84206-0115-
  84206-0115-1- 10 kg in 1 DRUM (84206-0115-1)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇