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Antabuse
Aka: Antabuse, Disulfiram
- Background
- Used since 1951
- 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
- Efficacy
- No better than Placebo in most studies
- May have better efficacy when administered under close supervision
- 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
-
Drug Interactions
- See contraindications above for other interactions
- Medications that raise Antabuse levels
- SSRI
- Tricyclic Antidepressants
- Dilantin
- Coumadin
- Isoniazid
- Unsteady gait
- 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
- 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)
- Management: Alcohol-Antabuse reaction
- Benadryl 50 mg IM
- Give additional Benadryl for home
- Labs (consider, done by some clinicians)
- Liver Function Tests
- Baseline, 2 weeks, 3 months and then every 6 months
- 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
- 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!
- Flavoring in frosting
- Sauces
- Wine Vinegar (14% Alcohol)
- Aerosol propellant (Hair spray)
- Skin absorption
- Alcohol swab on lab draw
- Hand lotion
- Soap
- Gel toothpaste
- Mouthwash
- Cough lozenge, Cough medications
- Nyquil (35% Alcohol)
- 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
- Safety
- Pregnancy Category C
- Lactation: Unknown
- Cost
- Cost: $190/month trade name (but generic available for $50 per month)
- References
- Mason (2001) J Clin Psychiatry 62:42-8 [PubMed]
- Winslow (2016) Am Fam Physician 93(6): 457-65 [PubMed]