Antabuse is a prescription medicine used to treat the symptoms of Alcoholism.

Antabuse may be used

alone or with other medications.

Antabuse belongs to a class of drugs called Psychiatry Agents, Other.

It is not known if Antabuse is safe and effective in children.

DEFINITION:

Disulfiram is an alcohol antagonist drug.

Chemical Name: bis(diethylthiocarbamoyl) disulfide.

Structural Formula:

(Disulfiram) Structural Formula Illustration

C10H20N2S4 M.W. 296.54

Disulfiram occurs as a white to off-white, odorless, and almost tasteless powder, soluble in water to the
extent of about 20 mg in 100 mL, and in alcohol to the extent of about 3.8 g in 100 mL.

Each tablet for oral administration contains 250 mg or 500 mg disulfiram, USP. Tablets also contain
colloidal silicon dioxide, anhydrous lactose, magnesium stearate, microcrystalline cellulose, sodium
starch glycolate, and stearic acid.

Indications :

Disulfiram is an aid in the management of selected chronic alcohol patients who want to remain in a
state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best
advantage.

Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive
therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic
alcoholic.

Dosage:

Disulfiram should never be administered until the patient has abstained from alcohol for at least 12
hours.

Initial Dosage Schedule

In the first phase of treatment, a maximum of 500 mg daily is given in a single dose for one to two
weeks. Although usually taken in the morning, disulfiram may be taken on retiring by patients who
experience a sedative effect. Alternatively, to minimize, or eliminate, the sedative effect, dosage may be
adjusted downward.
Maintenance Regimen

The average maintenance dose is 250 mg daily (range, 125 to 500 mg), it should not exceed 500 mg
daily.

Note: Occasionally patients, while seemingly on adequate maintenance doses of disulfiram, report that
they are able to drink alcoholic beverages with impunity and without any symptomatology. All
appearances to the contrary, such patients must be presumed to be disposing of their tablets in some
manner without actually taking them. Until such patients have been observed reliably taking their daily
disulfiram tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram
is ineffective.

Duration Of Therapy

The daily, uninterrupted administration of disulfiram must be continued until the patient is fully
recovered socially and a basis for permanent self-control is established. Depending on the individual
patient, maintenance therapy may be required for months or even years.

Trial With Alcohol

During early experience with disulfiram, it was thought advisable for each patient to have at least one
supervised alcohol-drug reaction. More recently, the test reaction has been largely abandoned.
Furthermore, such a test reaction should never be administered to a patient over 50 years of age. A
clear, detailed and convincing description of the reaction is felt to be sufficient in most cases.

However, where a test reaction is deemed necessary, the suggested procedure is as follows:

After the first one to two weeks' therapy with 500 mg daily, a drink of 15 mL (½ oz) of 100 proof
whiskey, or equivalent, is taken slowly. This test dose of alcoholic beverage may be repeated once only,
so that the total dose does not exceed 30 mL (1 oz) of whiskey. Once a reaction develops, no more
alcohol should be consumed. Such tests should be carried out only when the patient is hospitalized, or
comparable supervision and facilities, including oxygen, are available.

Management Of Disulfiram-Alcohol Reaction

In severe reactions, whether caused by an excessive test dose or by the patient's unsupervised ingestion
of alcohol, supportive measures to restore blood pressure and treat shock should be instituted. Other
recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), vitamin C
intravenously in massive doses (1 g) and ephedrine sulfate. Antihistamines have also been used
intravenously. Potassium levels should be monitored, particularly in patients on digitalis, since
hypokalemia has been reported.
Disulfiram Tablets USP

250 mg - White, round, unscored tablets, Debossed: OP 706

Bottles of NDC 54868-10 5034-2

Bottles of 30 NDC 54868-5034-1

Bottles of 100 NDC 54868-5034-0

Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as
required).

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].

Side effects :

OPTIC NEURITIS, PERIPHERAL NEURITIS, POLYNEURITIS, AND PERIPHERAL NEUROPATHY MAY OCCUR
FOLLOWING ADMINISTRATION OF DISULFIRAM.

Multiple cases of hepatitis, including both cholestatic and fulminant hepatitis, as well as hepatic failure
resulting in transplantation or death, have been reported with administration of disulfiram.

Occasional skin eruptions are, as a rule, readily controlled by concomitant administration of an

antihistaminic drug.

In a small number of patients, a transient mild drowsiness, fatigability, impotence, headache, acneform
eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may be experienced during the first
two weeks of therapy. These complaints usually disappear spontaneously with the continuation of
therapy, or with reduced dosage.

Psychotic reactions have been noted, attributable in most cases to high dosage, combined toxicity (with
metronidazole or isoniazid), or to the unmasking of underlying psychoses in patients stressed by the
withdrawal of alcohol.

Drug interactions:

Disulfiram appears to decrease the rate at which certain drugs are metabolized and therefore may
increase the blood levels and the possibility of clinical toxicity of drugs given concomitantly.

DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE PATIENTS RECEIVING PHENYTOIN AND ITS
CONGENERS, SINCE THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS CAN LEAD TO
PHENYTOIN INTOXICATION. PRIOR TO ADMINISTERING DISULFIRAM TO A PATIENT ON PHENYTOIN
THERAPY, A BASELINE PHENYTOIN SERUM LEVEL SHOULD BE OBTAINED. SUBSEQUENT TO INITIATION
OF DISULFIRAM THERAPY, SERUM LEVELS OF PHENYTOIN SHOULD BE DETERMINED ON DIFFERENT DAYS
FOR EVIDENCE OF AN INCREASE OR FOR A CONTINUING RISE IN LEVELS. INCREASED PHENYTOIN LEVELS
SHOULD BE TREATED WITH APPROPRIATE DOSAGE ADJUSTMENT.

It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram,
since disulfiram may prolong prothrombin time.

Patients taking isoniazid when disulfiram is given should be observed for the appearance of unsteady
gait or marked changes in mental status, the disulfiram should be discontinued if such signs appear

In rats, simultaneous ingestion of disulfiram and nitrite in the diet for 78 weeks has been reported to
cause tumors, and it has been suggested that disulfiram may react with nitrites in the rat stomach to
form a nitrosamine, which is tumorigenic. Disulfiram alone in the rat's diet did not lead to such tumors.
The relevance of this finding to humans is not known at this time

Warnings

Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or

without his full knowledge.

The physician should instruct relatives accordingly.

The patient must be fully informed of the disulfiram-alcohol reaction. He must be strongly cautioned
against surreptitious drinking while taking the drug, and he must be fully aware of the possible
consequences. He should be warned to avoid alcohol in disguised forms, i.e., in sauces, vinegars, cough
mixtures, and even in aftershave lotions and back rubs. He should also be warned that reactions may
occur with alcohol up to 14 days after ingesting disulfiram.failure, unconsciousness, convulsions, and
death.

The intensity of the reaction varies with each individual, but is generally proportional to the amounts of
disulfiram and alcohol ingested. Mild reactions may occur in the sensitive individual when the blood
alcohol concentration is increased to as little as 5 to 10 mg per 100 mL. Symptoms are fully developed at
50 mg per 100 mL, and unconsciousness usually results when the blood alcohol level reaches 125 to 150
mg.

The duration of the reaction varies from 30 to 60 minutes, to several hours in the more severe cases, or
as long as there is alcohol in the blood.

Receiving disulfiram ( CONTRAINDICATIONS).

Alcoholism may accompany or be followed by dependence on narcotics or sedatives. Barbiturates and

disulfiram have been administered concurrently without untoward effects; the possibility of initiating a
new abuse should be considered.
Hepatic toxicity including hepatic failure resulting in transplantation or death have been reported.
Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many
months of therapy. Hepatic toxicity has occurred in patients with or without prior history of abnormal
liver function. Patients should be advised to immediately notify their physician of any early symptoms of
hepatitis, such as fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, or dark urine.

resulting in a higher incidence of tumors and mortality in rats. A correlation between this finding and
humans, however, has not been demonstrated.

Usage In Pregnancy

The safe use of this drug in pregnancy has not been established. Therefore, disulfiram should be used
during pregnancy only when, in the judgement of the physician, the probable benefits outweigh the
possible risks.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Since many drugs are so excreted,
disulfiram should not be given to nursing mothers

Geriatric Use

A determination has not been made whether controlled clinical studies of disulfiram included sufficient
numbers of subjects aged 65 and over to define a difference in response from younger subjects. Other
reported clinical experience has not identified differences in responses between the elderly and younger
patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low
end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function,
and of concomitant disease or other drug therapy.

Overdosage

No specific information is available on the treatment of overdosage with disulfiram. It is recommended

that the physician contact the local Poison Control Center.

Contraindications

Patients who are receiving or have recently received metronidazole, paraldehyde, alcohol, or
alcoholcontaining preparations, e.g., cough syrups, tonics and the like, should not be given disulfiram.

Disulfiram is contraindicated in the presence of severe myocardial disease or coronary occlusion,

psychoses, and hypersensitivity to disulfiram or to other thiuram derivatives used in pesticides and
rubber vulcanization.
Clinical Pharmacology

Disulfiram produces a sensitivity to alcohol which results in a highly unpleasant reaction when the
patient under treatment ingests even small amounts of alcohol.

Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism
following disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10
times higher than that found during metabolism of the same amount of alcohol alone.

Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred
to hereinafter as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of
both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not
appear to influence the rate of alcohol elimination from the body.

Disulfiram is absorbed slowly from the gastrointestinal tract and is eliminated slowly from the body. One
(or even two) weeks after a patient has taken his last dose of disulfiram, ingestion of alcohol may
produce unpleasant symptoms.

Prolonged administration of disulfiram does not produce tolerance; the longer a patient remains on
therapy, the more exquisitely sensitive he becomes to alcohol.

Drug Abuse:

Prescription and nonprescription (over-the-counter) drug abuse involves using a drug for a purpose or in
a way other than what is prescribed by a doctor, or recommended on the package. For example, drugs
may be taken by people who were not prescribed the medication, people may take more of the drug
than prescribed, or they may crush pills and inhale them rather than swallowing them as directed. Some
commonly abused prescription drugs include depressants, pain relievers, and stimulants.

Disulfiram Nursing Considerations & Management

Initial dosage: Administer maximum of 500 mg/day PO in a single dose for 1–2 wk. If a sedative effect
occurs, administer at bedtime or decrease dosage.

Maintenance regimen: 125–500 mg/day PO. Do not exceed 500 mg/day. Continue use until patient is
fully recovered socially and a basis for permanent self-control is established.

Trial with alcohol (do not administer to anyone > 50 yr): After 1–2 wk of therapy with 500 mg/day PO, a
drink of 15 mL of 100 proof whiskey or its equivalent is taken slowly. Dose may be repeated once, if
patient is hospitalized and supportive facilities are available.

Therapeutic actions
Disulfiram inhibits aldehyde dehydrogenase, the oxidative enzyme of acetaldehyde, a metabolite of
alcohol. The latter is accumulated in the blood, thus producing unpleasant symptoms of disulfiram-
alcohol reaction when a patient has taken small amounts of alcohol.

Indications

Aids in the management of selected chronic alcoholics who want to remain in a state of enforced
sobriety

Adverse effects

Drowsiness, fatigue, lassitude, psychotic reactions, peripheral and optic neuropathies, hepatotoxicity,
garlic-like or metallic after-taste, GI upset, body odour, bad breath, headache, impotence.

Potentially Fatal: Respiratory depression, CV collapse, arrhythmias, myocardial infarction, acute CHF,
convulsions, sudden death.

Contraindications

Hypersensitivity, CVS diseases; peripheral neuropathy, psychosis. Not to be used in patients with alcohol
intoxication.

Nursing considerations

Assessment

History: Allergy to disulfiram or other thiuram derivatives; severe myocardial disease or coronary
occlusion; psychoses; current or recent treatment with metronidazole, paraldehyde, alcohol, alcohol-
containing preparations (eg, cough syrups, tonics); diabetes mellitus, hypothyroidism, epilepsy, cerebral
damage, chronic and acute nephritis, hepatic cirrhosis or impairment; pregnancy

Physical: Skin color, lesions; thyroid palpation; orientation, affect, reflexes; P, auscultation, BP; R,
adventitious sounds; liver evaluation; LFTs, renal function tests, CBC, SMA-12

Interventions

Do not administer until patient has abstained from alcohol for at least 12 hr.

Administer orally; tablets may be crushed and mixed with liquid beverages.

Monitor liver function tests before, in 10–14 days, and every 6 mo during therapy to evaluate for
hepatic impairment.

Monitor CBC, SMA-12 before and every 6 mo during therapy.

Inform patient of the seriousness of disulfiram-alcohol reaction and the potential consequences of
alcohol use. Disulfiram should not be taken for at least 12 hr after alcohol ingestion and a reaction may
occur up to 2 wk after disulfiram therapy is stopped; all forms of alcohol must be avoided.
Arrange for treatment with antihistamines if skin reaction occurs.

WARNING: Institute supportive measures if disulfiram-alcohol reaction occurs; oxygen, carbon dioxide
combination, massive doses of vitamin C IV, ephedrine have been used.

Teaching points

Take drug daily; if drug makes you dizzy or tired, take it at bedtime. Tablets may be crushed and mixed
with liquid.

Abstain from forms of alcohol (beer, wine, liquor, vinegars, cough mixtures, sauces, aftershave lotions,
liniments, colognes, liquid medications). Using alcohol while taking this drug can cause severe,
unpleasant reactions—flushing, copious vomiting, throbbing headache, difficulty breathing, even death.

Wear or carry a medical ID while you are taking this drug to alert any medical emergency personnel that
you are taking it.

Have periodic blood tests while taking drug to evaluate its effects on the liver.

You may experience these side effects: Drowsiness, headache, fatigue, restlessness, blurred vision (use
caution driving or performing tasks that require alertness); metallic aftertaste (transient).

Report unusual bleeding or bruising, yellowing of skin or eyes, chest pain, difficulty breathing, ingestion
of any alcohol.