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(die-SULL-fih-ram)
Antabuse
Class: Antialcoholic

 Action Produces intolerance to alcohol by blocking oxidation of acetaldehyde by enzyme aldehyde dehydrogenase, resulting in high blood levels of acetaldehyde and unpleasant physical symptoms.

 Indications Aid in management of alcoholism in selected patients who want to remain in state of enforced sobriety.

 Contraindications Hypersensitivity to thiuram derivatives used in pesticides and rubber vulcanization; severe myocardial disease or coronary occlusion; psychoses; patients receiving or who have recently received metronidazole, paraldehyde, alcohol or alcohol-containing products.

 Route/Dosage

ADULTS: PO 500 mg qd (single dose) initially for 1 to 2 wk. Maintenance dose: PO 125 to 500 mg qd (maximum 500 mg/day).

 Interactions

Alcohol: Causes severe alcohol-intolerance reaction. Symptoms include flushing, throbbing in head and neck, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitations, shortness of breath, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision and confusion. In severe reactions there may be respiratory depression, cardiovascular collapse, unconsciousness, convulsions and death. Anticoagulants: Disulfiram may increase anticoagulant effect. Antidepressants, tricyclic: May produce acute organic brain syndrome. Benzodiazepines: Disulfiram decreases plasma clearance of benzodiazepines metabolized by oxidation. Hydantoins: Disulfiram may increase serum hydantoin levels. Isoniazid: Acute behavioral and coordination changes. Metronidazole: May cause patients to exhibit acute toxic psychosis or confusional state. One or both agents may need to be discontinued. Theophyllines: Disulfiram may inhibit metabolism and increase effect of theophyllines.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Drowsiness; fatigue; headache; depression; restlessness; psychotic reactions. DERM: Skin eruptions. EENT: Metallic or garlic-like aftertaste. HEPA Hepatotoxicity; hepatitis. OTHER: Peripheral neuropathy; polyneuritis; optic or retrobulbar neuritis; arthropathy; impotence.

 Precautions

Pregnancy: Undetermined. Lactation: Undetermined. Special risk patients: Use with caution in patients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis and hepatic cirrhosis or insufficiency. Disulfiram-alcohol reaction: Avoid alcohol in all forms, including alcoholic beverages, vinegars, liquid medications such as cough syrups or tonic, some sauces and aftershave products. Do not give disulfiram within 12 hr of drinking alcohol. Reactions can occur up to 2 wk after discontinuing disulfiram. Ethylene dibromide: Patients receiving disulfiram should not be exposed to ethylene dibromide or its vapors; toxic interaction resulting in tumors and death has occurred in research animals. Hypersensitivity. Evaluate patients with history of rubber contact dermatitis for hypersensitivity to thiuram derivatives. Intoxication: Never give drug to intoxicated patient or without patient’s knowledge.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Do not administer until patient has abstained from alcohol for ³ 12 hr.
  • May crush or mix tablets with liquid.
  • May administer at bedtime if sedative effect is experienced.
  • Store medication at room temperature in amber-colored bottle.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Perform physical and psychosocial assessment to determine patient’s readiness to initiate this type of drug therapy.
  • Obtain baseline chemistry (specifically AST, ALT) and blood and urine alcohol level with follow-up testing (10 to 14 days) to detect hepatic dysfunction. Perform CBC and SMA-12 test q 6 mo.
  • Evaluate history to ensure patient has not ingested any form of alcohol within 12 hr prior to initiation of therapy (including cough syrups, tonics and vinegars).
  • For treatment of severe reaction to alcohol, be prepared to institute supportive measures to restore BP and to treat shock. Other measures may include oxygen, vitamin C administered intravenously in massive doses (1 g) and ephedrine sulfate. Intravenous antihistamines may also be used.
  • Monitor potassium levels, especially in patients receiving digitalis, because hypokalemia has been reported.
OVERDOSAGE: SIGNS & SYMPTOMS
  Lethargy, vomiting, tachypnea, seizures, ketosis, coma

 Patient/Family Education

  • Explain that disulfiram will not cure alcohol dependence and should be used in conjunction with psychotherapy.
  • Advise patient that even trace amounts of alcohol in some food products or alcohol absorbed through skin (eg, aftershave lotion) can precipitate reaction.
  • Inform patient of all effects that will occur if alcohol is ingested while taking this medication.
  • Advise patient and family that some alcohol-disulfiram reactions can have serious effects on heart and respiratory systems that may require immediate emergency treatment.
  • Instruct patients to read all product labels or consult pharmacist about alcohol content of all liquid medications before choosing one.
  • Instruct patient to carry Medi-Alert identification while taking this drug. Information should include physician’s phone number or name of medical facility that should be contacted in case of reaction.
  • Caution patient that prolonged disulfiram therapy does not produce tolerance to alcohol but increased sensitivity.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Explain that alcohol-disulfiram reactions may occur for several wks after discontinuation of therapy.

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