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Disulfiram

Brands and Forms

  • Antabuse
    • tablet: 250mg

Uses of Disulfiram

Disulfiram can be used for preventing a relapse of alcohol use in individuals who have recovered from alcohol abuse or dependence.

It should only be used by individuals who are conscientious, motivated, and not impulsive, and who have already demonstrated some capacity to limit their alcohol use.

How Disulfiram Works

Disulfiram blocks the actions of the aldehyde dehydrogenase enzyme, which is involved in normal alcohol metabolism. When this enzyme is blocked, alcohol consumption causes toxic levels of acetaldehyde to accumulate, which in turn is associated with a host of unpleasant and potentially dangerous symptoms, including flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion.

The purpose of Disulfiram is to disuade the patient from consuming alcohol. However, it is only effective to the degree that an alcohol-using individual adheres to taking it as prescribed.

Cautions when Using Disulfiram

When combined with alcohol, Disulfiram can cause severe and potentially life-threatening reactions, including respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.

It should not be used in individuals with a high likelihood of using alcohol.

It should not be used by individuals who have cardiovascular disease, seizure disorder, liver problems, respiratory diseases, or are in other ways frail and in poor health.

All forms of alcohol should be avoided when taking Disulfiram, including vinegars, sauces or dishes that have been prepared with wine, and cough syrup.

Dosing of Disulfiram

Disulfiram should never be started within 12 hours of consuming alcohol.

The initial dose is 500mg/day, which is actually the maximum dose of the medication. It can be given once a day, usually in the morning. This dose should be continued for 1-2 weeks. Thereafter, the dose can be lowered to 250mg/day. The usual dose range is 125-500mg/day.

Onset of action

After a single dose Disulfiram can be expected to be effective.

Side-effects of Disulfiram

Below is a list of most of the reported side-effects of Disulfiram. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Cardiovascular: drowsiness; fatigue; headache.

Central Nervous System: peripheral neuropathy.

Dermatologic: skin eruptions; allergic dermatitis; acneform eruptions.

Eyes, Ears, Nose and Throat: metallic or garlic-like aftertaste.

Gastrointestinal: hepatotoxicity; hepatitis (including cholestatic and fulminant).

Genitourinary: impotence.

Psychiatric: psychosis.

Common side-effects of Disulfiram

Drowsiness, fatigue, headache.

Rare but serious side-effects of note of Disulfiram

Liver toxicity and damage.

Disulfiram and pregnancy

Category C: some animal studies show adverse effects at very high doses, but no controlled human studies have been done; should only be used in pregnancy if clearly needed and if benefits outweigh potential risks.

Medical Monitoring for Disulfiram

Liver function tests should be measured about 2 weeks after starting treatment and then periodically during treatment.

Drug Interactions with Disulfiram

  • Disulfiram may increase the anticoagulant effect of anticoagulants.
  • Disulfiram may increase blood levels of certain benzodiazepines, hydrantoins, and theophyllines.
  • Liver impairment may occur if combined with Naltrexone.