Disulfiram

Brand names

• Antabuse

Usage

To help treat chronic alcoholism.

How it works

Disulfiram interferes with the activity of the liver enzyme that processes and metabolizes alcohol, causing an accumulation of a chemical known as "acetaldehyde:' A buildup of acetaldehyde in the body leads to a severely unpleasant reaction, including nausea and vomiting. Thus, while not a cure for alcoholism, disulfiram is a deterrent to alcohol consumption.

Side effects

Serious

Confusion and disorientation, severe skin rash, seizures, neuritis (nerve inflammation causing pain, numbness, or paralysis), low thyroid function, decrease or increase in blood pressure, carpal tunnel syndrome. Seek medical help if such symptoms arise.

Common

Drowsiness.

Less common

Eye pain, vision changes, abdominal discomfort, throbbing headache, mood change, numbness in hands and feet, decreased sexual ability in men, unpleasant taste in mouth, offensive breath and body odor.

Possible interactions

Other medicaments:

Disulfiram may increase the effects of:

• chlordiazepoxide (Librium) and diazepam (Valium) and cause over sedation. Other benzodiazepines such as alprazolam, clonazepam, clorazepate, flurazepam, halazepam, prazepam or triazolam may also be subject to this interaction.
• oral anticoagulants (warfarin, etc.) and increase the risk of bleeding; dose adjustments may be necessary.
• paraldehyde and cause excessive depression of brain function.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) and cause toxicity; dose must be decreased.

Disulfiram may decrease the effects of:

• perphenazine (Trilafon, etc.).

Disulfiram taken concurrently with:

• bacampicillin (Spectrobid) can theoretically cause a disulfiram reaction, but no cases have been reported.
• cisplatin (Platinol) can increase risk of toxicity of cisplatin.
• cyclosporine (Sandimmune) may result in a disulfiram reaction, as there is alcohol in the intravenous and oral forms of cyclosporine.
• isoniazid (INH, etc.) may cause acute mental problems and incoordination.
• metronidazole (Flagyl) may cause acute mental and behavioral disturbances, making it necessary to stop treatment.
• omeprazole (Prilosec) may result in increased disulfiram levels and toxicity.
• over-the-counter (OTC) cough syrups, tonics, etc., containing alcohol may cause a disulfiram (Antabuse) reaction; avoid concurrent use.
• paraldehyde may result in a disulfiram reaction.
• theophylline (Theo-Dur, others) can lead to theophylline toxicity because the metabolism of theophylline is decreased.
• tranylcypromine (Parnate) can increase risk of hallucinations, disorientation and agitation. Monitor the patient closely if these two medicines must be used together.
• warfarin will result in an increased risk of bleeding. More frequent INR testing is recommended.

The following medicaments may increase the effects of disulfiram:

• amitriptyline (Elavil) and perhaps other tricyclic antidepressants may enhance the disulfiram-alcohol interaction; avoid concurrent use of these medicaments.

Foods:

Avoid all foods prepared with alcohol, including sauces, marinades, vinegars, desserts, etc.

Herbal medicines or minerals:

Many herbal medicines such as ginseng and Echinacea contain alcohol. Do not combine them with disulfiram. Using St. John's wort, ma huang, ephedrine-like compounds or kola while trying to stop drinking may worsen jitteriness and anxiety.

Beverages:

Avoid all punches, fruit drinks, etc., that may contain alcohol.

Alcohol:

Avoid completely in all forms while taking this medicament and for 14 days after the last dose. Disulfiram and alcohol-even in small amounts-produces the disulfiram (Antabuse) reaction. This starts 5 to 10 minutes after alcohol: intense flushing, severe headache, shortness of breath, chest pains, nausea, repeated vomiting, sweating and weakness. If large amounts of alcohol: reaction may progress to blurred vision, vertigo, confusion, severely low blood pressure and loss of consciousness. May go on to convulsions and death. Reaction may last from 30 minutes to hours, depending upon amount of alcohol and disulfiram.

Marijuana smoking:

Possible increase in drowsiness or lethargy.

Exposure to environmental chemicals:

Thiram, a pesticide, and carbon disulfide, a pesticide and industrial solvent, can have additive toxic effects. Watch for toxic effects on the brain and nervous system.

Discontinuation:

This medicine is only part of your program. Do not stop it unless you have talked with your doctor. Even if it is stopped, no alcohol should be ingested for 14 days.

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