Yes

Aldehyde Dehydrogenase Inhibitor

Management of chronic alcoholism

C

Severe myocardial disease and coronary occlusion; psychoses; hypersensitivity to disulfiram and related compounds or any component; patients receiving or using alcohol, metronidazole, paraldehyde, or alcohol-containing preparations like cough syrup or tonics

Use with caution in patients with diabetes, hypothyroidism, seizure disorders, nephritis (acute or chronic); hepatic cirrhosis or insufficiency; should never be administered to a patient when he/she is in a state of alcohol intoxication, or without his/her knowledge. Patient must receive appropriate counseling, including information on "disguised" forms of alcohol (tonics, mouthwashes, etc) and the duration of the drug's activity (up to 14 days).

Central nervous system: Drowsiness, headache, fatigue, psychosis

Dermatologic: Rash, acneiform eruptions, allergic dermatitis

Gastrointestinal: Metallic or garlic-like aftertaste

Genitourinary: Impotence

Hepatic: Hepatitis

Neuromuscular & skeletal: Peripheral neuritis, polyneuritis, peripheral neuropathy

Ocular: Optic neuritis

Management of disulfiram reaction: Institute support measures to restore blood pressure (pressors and fluids); monitor for hypokalemia

CYP2C9 and 2E1 enzyme inhibitor, both disulfiram and diethyldithiocarbamate (disulfiram metabolite) are CYP3A3/4 enzyme inhibitors

Disulfiram increases phenytoin and theophylline serum concentrations; toxicity may occur

Disulfiram inhibits the metabolism of warfarin resulting in an increased hypoprothombinemic response

Disulfiram results in severe ethanol intolerance (Antabuse® reaction) secondary to disulfiram's ability to inhibit aldehyde dehydrogenase; this combination should be avoided

Combined use with isoniazid, metronidazole, or MAOIs may result in adverse CNS effects; this combination should be avoided

Intravenous trimethoprim-sulfamethoxazole contains 10% ethanol as a solubilizing agent and may interact with disulfiram; monitor for Antabuse® reaction

Disulfiram is a thiuram derivative which interferes with aldehyde dehydrogenase. When taken concomitantly with alcohol, there is an increase in serum acetaldehyde levels. High acetaldehyde causes uncomfortable symptoms including flushing, nausea, thirst, palpitations, chest pain, vertigo, and hypotension. This reaction is the basis for disulfiram use in postwithdrawal long-term care of alcoholism.

Onset of action: Full effect: 12 hours

Duration: May persist for 1-2 weeks after last dose

Absorption: Rapid from GI tract

Full effect: 12 hours

Metabolism: To diethylthiocarbamate

Adults: Oral: Do not administer until the patient has abstained from alcohol for at least 12 hours

Average maintenance dose: 250 mg/day; range: 125-500 mg; duration of therapy is to continue until the patient is fully recovered socially and a basis for permanent self control has been established; maintenance therapy may be required for months or even years

Alcohol: Avoid use, including alcohol-containing products

Psychotic reactions have been noted

No information available to require special precautions

No effects or complications reported

Tablets can be crushed or mixed with water or juice. Metallic aftertaste may occur; this will go away. Do not drink any alcohol, including products containing alcohol (cough and cold syrups), or use alcohol-containing skin products for at least 3 days and preferably 14 days after stopping this medication or while taking this medication. Drowsiness, tiredness, or visual changes may occur. Use care when driving or engaging in tasks requiring alertness until response to drug is known. Report yellow color in eyes or skin and any respiratory difficulty. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Administration of any medications containing alcohol including topicals is contraindicated

Tablet: 250 mg, 500 mg

Motte S, Vincent JL, and Gillet JB, "Refractory Hyperdynamic Shock Associated With Alcohol and Disulfiram," Am J Emerg Med, 1986, 4(4):323-5.

Pompidou A, Delsaux MC, Telvi L, et al, "Isoprinosine and Imuthiol, Two Potentially Active Compounds in Patients With AIDS-Related Complex Symptoms," Cancer Res, 1985, 45(9 Suppl):4671S-4673S.