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Antabuse

Aka: Antabuse, Disulfiram
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  1. Background
    1. Used since 1951
  2. Mechanism
    1. Buildup of acetaldehyde if drinks on Antabuse
    2. Taking Antabuse seals daily sobriety contract
      1. Today they will not drink
  3. Efficacy
    1. No better than Placebo
  4. Contraindications
    1. Concurrent use of medications with drug interaction
      1. Metronidazole (Flagyl)
      2. Medication containing Alcohol (e.g. some inhalers)
    2. Age over 60 years
    3. Comorbid illness
      1. Cirrhosis with Portal Hypertension
      2. Coronary Artery Disease
      3. Chronic Renal Failure
      4. Diabetes Mellitus
      5. Peripheral Neuropathy
      6. Seizure disorder
      7. Severe respiratory disease
    4. Prior Psychosis on Antabuse
  5. Medication Interactions
    1. See contraindications above for other interactions
    2. Medications that raise Antabuse levels
      1. SSRI
      2. Tricyclic Antidepressants
      3. Dilantin
      4. Coumadin
      5. Isoniazid
      6. Unsteady gait
  6. Symptoms and Signs of Antabuse with Alcohol reaction
    1. Headache
    2. Nausea and Vomiting
    3. Large red hot pruritic rash
    4. Shortness of Breath
    5. Cardiac Arrest
    6. Seizure
    7. Coma
    8. Death
  7. Adverse Effects of Antabuse alone
    1. Fatigue (resolves after 2-3 weeks)
    2. Garlic breath
    3. Metallic Taste
    4. Acne (Treat with non-Alcohol based Comedolytic)
    5. Rare neurologic sequelae
    6. Rare hepatotoxicity
  8. Management of Alcohol-Antabuse reaction
    1. Benadryl 50 mg IM
      1. Give additional Benadryl for home
  9. Lab Monitoring (consider, done by some clinicians)
    1. Liver Function Tests
      1. Baseline, 2 weeks, 3 months and then every 6 months
  10. Pregnancy
    1. Category C
  11. Dose
    1. Antabuse 250 mg PO qd
  12. Precautions
    1. Counsel: life threatening risk Alcohol and Antabuse
    2. If choosing to drink, wait 14 days after last Antabuse
    3. Alcohol-Antabuse reactions occur at low Alcohol levels
    4. Do not use Flagyl with Antabuse
    5. Read Labels: Alcohol is in many products!
      1. Flavoring in frosting
      2. Sauces
      3. Wine Vinegar (14% Alcohol)
      4. Aerosol propellant (Hair spray)
      5. Skin absorption
        1. Alcohol swab on lab draw
        2. Hand lotion
        3. Soap
      6. Gel toothpaste
      7. Mouthwash
      8. Cough lozenge, Cough medications
      9. Nyquil (35% Alcohol)
    6. Every patient must have a medic alert card
      1. Alerts that patient is in on Antabuse
      2. Do not give Alcohol, paraldehyde or related product
    7. Every patient should sign a witnessed consent
    8. Patient Education handouts are highly recommended
    9. Document that the above has been reviewed with patient
Medication Costs
Antabuse (on 2/9/2012 at DrugStore.com)
Antabuse 250mg Tablets #30 for $135.27 ($4.51/unit)
Antabuse 500mg Tablets #30 for $217.10 ($7.24/unit)
Disulfiram (on 2/9/2012 at DrugStore.com)
Disulfiram 250mg Tablets #30 for $119.99 ($4.00/unit)
Disulfiram 500mg Tablets #30 for $179.99 ($6.00/unit)
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Disulfiram (C0012772)

Definition (MSH) A carbamate derivative used as an alcohol deterrent. It is a relatively nontoxic substance when administered alone, but markedly alters the intermediary metabolism of alcohol. When alcohol is ingested after administration of disulfiram, blood acetaldehyde concentrations are increased, followed by flushing, systemic vasodilation, respiratory difficulties, nausea, hypotension, and other symptoms (acetaldehyde syndrome). It acts by inhibiting aldehyde dehydrogenase.
Definition (CSP) carbamate derivative used as an alcohol deterrent; it is a relatively nontoxic substance when administered alone, but markedly alters the intermediary metabolism of alcohol; when alcohol is ingested after administration of disulfiram, blood acetaldehyde concentrations are increased, followed by flushing, systemic vasodilation, respiratory difficulties, nausea, hypotension, and other symptoms (acetaldehyde syndrome); it acts by inhibiting aldehyde dehydrogenase.
Definition (NCI) A drug that slows the metabolism of retinoids, allowing them to act over a longer period of time.
Definition (NCI) A carbamoyl derivate used in the treatment of alcoholism. Disulfiram irreversibly inhibits acetaldehyde dehydrogenase that oxidizes the ethanol metabolite acetaldehyde into acetic acid. This leads to an accumulation of acetaldehyde that produces a variety of very unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction includes , but is not limited to, flushing, headache, respiratory difficulty, nausea,vomiting, sweating, thirst, chest pain, tachycardia, blurred vision and hypotension.
Definition (PDQ) A carbamoyl derivate used in the treatment of alcoholism. Disulfiram irreversibly inhibits acetaldehyde dehydrogenase that oxidizes the ethanol metabolite acetaldehyde into acetic acid. This leads to an accumulation of acetaldehyde that produces a variety of very unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction includes , but is not limited to, flushing, headache, respiratory difficulty, nausea,vomiting, sweating, thirst, chest pain, tachycardia, blurred vision and hypotension. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42291&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42291&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C447" NCI Thesaurus)
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D004221
SnomedCT 411488001, 256160001, 39516004, 387212009
English Bis(diethylthiocarbamoyl) Disulfide, Disulfide, Tetraethylthiuram, Tetraethylthiuram Disulfide, disulfiram, Thioperoxydicarbonic diamide (((H2N)C(S))2S2), tetraethyl-, TTD, Tetraethylthioperoxydicarbonic Diamide, Teturamin, DS, Tetraethylthiuram disulfide (product), Tetraethylthiuram disulfide (substance), Tetraethylthioperoxydicarbonic Diamide, ((H2N)C(S))2S2, Disulphiram product, Disulphiram, disulfiram (medication), DISULFIRAM, Disulfiram [Chemical/Ingredient], disulphiram, tetraethylthiuram disulfide, Tetraethylthiuram disulfide, Tetraethylthiuram disulphide, Disulfiram product, Disulfiram (product), Disulfiram (substance), Disulfiram
Swedish Disulfiram
Czech disulfiram
Spanish disulfuro de tetraetiltiuram, disulfuro de tetraetiltiuram (producto), disulfuro de tetraetiltiuram (sustancia), disulfiram (producto), disulfiram (sustancia), disulfiram, tetraetiltiuram disulfuro, Disulfiram, Disulfuro de Tetraetiltiuramo
Finnish Disulfiraami
Russian ANTABUS, ETILDITIURAM, TETURAM, DISUL'FIRAM, TETRAETILTIURAMDISUL'FID, АНТАБУС, ДИСУЛЬФИРАМ, ТЕТРАЭТИЛТИУРАМДИСУЛЬФИД, ТЕТУРАМ, ЭТИЛДИТИУРАМ
Japanese ジスルフィラム, テトラエチルチウラムジスルフィド
French Disulfiram, Disulfirame
Italian Disulfuro tetraetiltiuramo, Disulfiram
Croatian DISULFIRAM
Polish Antabus, Disulfiram, Anicol
German Disulfiram, Tetraethylthiuramdisulfid
Portuguese Dissulfeto de Tetraetiltiuramo, Dissulfiram, Tetraetiltiuramo Dissulfeto
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Antabuse (C0591096)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D004221
French Antabuse
English antabuse, Antabuse, Allphar Brand of Disulfiram, Odyssey Brand of Disulfiram, Orphan Brand of Disulfiram
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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