BMA Concise Guide to Medicine & Drugs

Disulfiram

Brand name Antabuse

Used in the following combined preparations None

QUICK REFERENCE

Drug group Alcohol abuse deterrent

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Disulfiram is used to help alcohol misusers abstain from alcohol. It does not cure alcoholism but provides a powerful deterrent to drinking.

If you are taking disulfiram and drink even a small amount of alcohol, highly unpleasant reactions follow. These are due to high levels of acetaldehyde in the body because disulfiram prevents its breakdown. Flushing, throbbing headache, nausea, breathlessness, thirst, palpitations, dizziness, and fainting may be experienced. Such reactions may last from 30 minutes to several hours, leaving you feeling drowsy and fatigued. The reactions can also include unconsciousness, so it is wise to carry a card stating the person to be notified in an emergency.

It is important not to drink any alcohol for at least 24 hours before beginning disulfiram treatment, and for at least a week after stopping. Foods, medicines, and even toiletries that contain alcohol should also be avoided. Disulfiram treatment is usually only started by specialist services and in conjunction with social support.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily.

Adult dosage range 800mg initially, gradually reduced over 5 days to 100–200mg (maintenance dose).

Onset of effect Interaction with alcohol occurs within a few minutes of taking alcohol.

Duration of action Interaction with alcohol can occur for up to 6 days after the last dose of disulfiram.

Diet advice Avoid all alcoholic drinks, even in very small amounts. Food, fermented vinegar, medicines, mouthwashes, and lotions containing alcohol should also be avoided.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause a temporary increase in adverse effects. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Adverse effects, such as drowsiness, fatigue, nausea, vomiting, bad breath, and reduced libido, may occur but usually disappear when you get used to the drug. If they persist or become severe, discuss with your doctor; the dosage may need to be adjusted. The most potentially severe effects are due to interaction with alcohol (see General information).

INTERACTIONS

General note A number of drugs can produce an adverse reaction when taken with disulfiram. You are advised to check with your doctor or pharmacist before taking any other medication.

Phenytoin Disulfiram increases the blood levels of this drug.

Anticoagulant drugs (e.g. warfarin) Disulfiram increases the effect of these drugs.

Metronidazole A severe reaction can occur if this drug is taken with disulfiram.

Theophylline Disulfiram may increase the toxic effects of this drug.

Diazepam/chlordiazepoxide Disulfiram increases the effect of these drugs.

Tricyclic antidepressants Disulfiram increases the blood levels of these drugs.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have heart problems, coronary artery disease, or high blood pressure, or have had a previous stroke.

· You have had epileptic seizures.

· You have diabetes.

· You have breathing problems.

· You have depression.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby adversely. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how disulfiram affects you because the drug can cause drowsiness and dizziness.

Alcohol Never drink alcohol while under treatment with disulfiram, and avoid foods, medicines, and toiletries containing alcohol. This drug may interact dangerously with alcohol.

PROLONGED USE

Not usually prescribed for longer than 6 months without review. It is wise to carry a card indicating you are taking disulfiram with instructions as to who should be notified in an emergency.