II. Background
- Used since 1951
III. Mechanism
- Buildup of acetaldehyde if drinks on Disulfiram, with secondary severe reaction
- Taking Antabuse seals daily sobriety contract
- Today they will not drink
- Does not reduce Alcohol craving
IV. Efficacy
- No better than Placebo in most studies
- May have better efficacy when administered under close supervision
V. Contraindications
- Concurrent use of medications with Drug Interaction
- Metronidazole (Flagyl)
- Medication containing Alcohol (e.g. some Inhalers)
- Age over 60 years
- Comorbid illness
- Cirrhosis with Portal Hypertension
- Coronary Artery Disease
- Chronic Renal Failure
- Diabetes Mellitus
- Peripheral Neuropathy
- Seizure Disorder
- Severe respiratory disease
- Prior Psychosis on Antabuse
VI. Drug Interactions
- See contraindications above for other interactions
- Medications that raise Antabuse levels
- SSRI
- Tricyclic Antidepressants
- Dilantin
- Coumadin
- Isoniazid
- Unsteady gait
VII. Adverse Effects: Symptoms and Signs of Antabuse with Alcohol reaction
- Headache
- Nausea and Vomiting
- Large red hot pruritic rash
- Shortness of Breath
- Cardiac Arrest
- Seizure
- Coma
- Death
VIII. Adverse Effects: Antabuse alone
- Fatigue (resolves after 2-3 weeks)
- Garlic breath
- Metallic Taste
- Acne (Treat with non-Alcohol based Comedolytic)
- Rare neurologic sequelae
- Rare hepatotoxicity
- Peripheral Neuropathy (or neuritis)
X. Labs (consider, done by some clinicians)
-
Liver Function Tests
- Baseline, 2 weeks, 3 months and then every 6 months
XI. Dose
- Antabuse 250 mg orally daily (may be increased up to 500 mg daily)
- Do not start for at least 12 hours from last Alcohol intake
XII. Precautions
- Counsel: life threatening risk Alcohol and Antabuse
- If choosing to drink, wait 14 days after last Antabuse
- Alcohol-Antabuse reactions occur at low Alcohol levels
- Do not use Flagyl with Antabuse
- Read Labels: Alcohol is in many products!
- Every patient must have a medic alert card
- Alerts that patient is in on Antabuse
- Do not give Alcohol, paraldehyde or related product
- Every patient should sign a witnessed consent
- Patient Education handouts are highly recommended
- Document that the above has been reviewed with patient
XIII. Safety
- Pregnancy Category C
- Lactation: Unknown
XIV. Cost
- Cost: $190/month trade name (but generic available for $50 per month)
Images: Related links to external sites (from Bing)
Related Studies
| disulfiram (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DISULFIRAM 250 MG TABLET | Generic | $1.53 each |