Disulfiram Full Prescribing Information

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Brand Name: Antabuse
Generic Name: Disulfiram

Antabuse (Disulfiram) is an addiction medication for alcoholism treatment. Detailed info on uses, dosage and side-effects of Disulfiram below.

Contents:

Description
Pharmacology
Indications and Usage
Contraindications
Warnings
Precautions
Adverse Reactions
Overdose
Dosage
Supplied

Antabuse patient information (in plain English)

Description

Antialcoholic. Disulfiram (Antabuse) produces a sensitivity to alcohol which results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol.

Pharmacology

Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism after disulfiram (Antabuse) intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone.

Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not appear to influence the rate of alcohol elimination from the body.

Disulfiram (Antabuse) plus even small amounts of alcohol produces flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions, there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The intensity of the reaction may vary with each individual but is generally proportional to the amount of disulfiram and alcohol ingested. In the sensitive individual, mild reactions may occur when the blood alcohol concentration is increased to as little as 5 to 10 mg/100 mL. At a concentration of 50 mg/100 mL symptoms are usually fully developed, and when the concentration reaches 125 to 150 mg/100 mL unconsciousness may occur.

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The duration of the reaction is variable, from 30 to 60 minutes in mild cases, up to several hours in more severe cases or as long as there is alcohol remaining in the blood. In severe reactions, supportive measures to restore blood pressure and treat shock should be instituted. Other measures such as the administration of oxygen or carbogen (95% oxygen, 5% carbon dioxide), massive i.v. doses of vitamin C (1 g), ephedrine sulfate, or antihistamines i.v. might be indicated. Potassium levels should be monitored particularly in patients on digitalis since hypokalemia has been reported.

Disulfiram is slowly absorbed from the gastrointestinal tract and is slowly eliminated from the body. Ingestion of alcohol may produce unpleasant symptoms 1 or even 2 weeks after a patient has taken his last dose of disulfiram.

Prolonged administration of disulfiram does not produce tolerance. The longer a patient remains on therapy the more sensitive he becomes to alcohol.

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Indications and Usage

As an aid in the management of selected chronic alcoholic patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage.

Used alone, without proper motivation and without supportive therapy, disulfiram is not a cure for alcoholism, and it is unlikely that it will have more than a brief effect on the drinking pattern of the chronic alcoholic.

Contraindications

Patients who are receiving or have recently received metronidazole, paraldehyde, alcohol, or alcohol-containing preparations such as cough syrups, elixirs, should not be given disulfiram. Severe myocardial disease or coronary occlusion; diabetes mellitus; hepatic cirrhosis or insufficiency; hypothyroidism; epilepsy; cerebral damage; chronic and acute nephritis; psychoses; and hypersensitivity to disulfiram or other thiuram derivatives used in the manufacture of items such as pesticides or vulcanized rubber.

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Warnings

Disulfiram should never be administered to a patient without his full knowledge or when he is in a state of alcohol intoxication. The attending physician should instruct those tending the patient accordingly.

Patients must be fully informed about the disulfiram-alcohol reaction. They must be strongly cautioned against surreptitious drinking while taking the drug and must be fully aware of possible consequences. They should be warned to avoid alcohol in disguised form, i.e., in sauces, vinegars, cough and cold mixtures, and even aftershave lotions or liniments. They should also be warned that reactions may occur with alcohol up to 14 days after ingestion of disulfiram.

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Precautions

AVOID ALL ALCOHOL INCLUDING alcohol found in sauces, vinegar, mouthwash, liquid medicines, lotions, after shave, or backrub products. A reaction to alcohol may cause flushing, nausea, thirst, abdominal pain, chest pain, dizziness, vomiting, fast breathing, fast heartbeat, fainting, difficult breathing, or confusion. Use caution when using topical products containing alcohol, such as cologne or perfume. Before using alcohol-containing products on the skin, test the product by applying some to a small area of the skin. If no redness, itching, headache, or nausea occur after 1 to 2 hours, you should be able to use the product.

Patients should be informed of the type of reaction which will be encountered if alcohol is taken overtly or as a component of food or other products.

Patients having a history of industrial contact dermatitis who currently work or have previously worked in the rubber industry should be evaluated for hypersensitivity to thiuram derivatives before receiving disulfiram.

Patients exposed to organic solvents which may contain alcohol, acetaldehyde, paraldehyde or structural analogues are at risk of experiencing disulfiram alcohol reactions. Such exposure should be eliminated prior to treatment.

It is suggested that every patient under treatment carry an identification card stating that he is receiving disulfiram and describing the symptoms most likely to occur as a result of the disulfiram-alcohol reaction. In addition, this card should identify the attending physician or institution to be contacted in emergency. (Cards may be obtained from Ayerst upon request.)

Alcoholism may be associated or followed by dependence on narcotics or sedatives. Barbiturates have been administered concurrently with disulfiram without untoward effects, but the possibility of initiating a new dependence should be considered. Patients taking disulfiram should not be exposed to ethylene dibromide or its vapors. This precaution is based on animal studies which have suggested a possible toxic reaction between inhaled dibromide and ingested disulfiram. Rats exposed to this regimen have shown a higher incidence of tumors and mortality. Correlation of this finding in humans however has not been demonstrated.

Since disulfiram-alcohol reactions could aggravate some medical conditions such as diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or hepatic insufficiency, disulfiram should be used with extreme care in patients having such a medical history. Baseline and follow-up transaminase tests (10 to 14 days) are suggested to detect any hepatic dysfunction that may be associated with disulfiram therapy. In addition, a complete blood count and a sequential multiple analysis-12 test (SMA-12) should be carried out every 6 months.

Disulfiram inhibits enzyme induction and may thus interfere with the metabolism of drugs taken concomitantly. It enhances the effects of the coumarin anticoagulants and phenytoin. Consequently, in patients on oral anticoagulants, such dosage should be adjusted. In patients on phenytoin therapy, a baseline phenytoin serum level should be obtained before initiation of disulfiram therapy. After initiation of therapy, serum levels should be reevaluated on different days for evidence of an increase or continuing rise in levels. Appropriate dosage adjustment should be made, if elevated levels are found. Disulfiram should be discontinued in patients taking isoniazid if an unsteady gait develops or there are marked changes in mental state.

Pregnancy and Nursing: It is not known whether disulfiram can cause fetal harm when administered during pregnancy, but one report of limb reduction anomalies in infants born to disulfiram-treated mothers has been published. Because of these findings, extreme care should be exercised before administering disulfiram during pregnancy.

It is not known whether this drug is excreted in human milk. Since many drugs are, and because of the potential for serious adverse reactions in the nursing infants, before administering disulfiram to a nursing mother it would appear advisable to discontinue nursing.

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Adverse Reactions

Optic neuritis, peripheral neuritis, polyneuritis may occur following administration of disulfiram. Multiple cases of both cholestatic and fulminant hepatitis have been reported following administration of the drug. Occasional skin eruptions have been reported. In a small number of patients, a transient mild drowsiness, fatigue, impotence, headache, acneiform eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may be experienced during the first 2 weeks of therapy. These complaints usually disappear later during therapy or with reduced dosage. Psychotic reactions have been noted, in most cases attributable to high dosage, associated toxicity with other drugs (metronidazole or isoniazid), or the unmasking of underlying psychoses in patients stressed by withdrawal of alcohol.

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Overdose

Severe cases of disulfiram poisoning have been reported mainly in children. Within a few hours of ingestion of a large amount, drowsiness followed by coma develop accompanied by persistent nausea, vomiting, aggressive and psychotic behavior, and ascending flaccid paralysis which can reach the cranial nerves.

Treatment

If you or someone you know may have used more than the recommended dose of this medicine, contact your local poison control center or emergency room immediately.

Treatment consists of administration of oxygen therapy, glucose 5% i.v., and sodium ascorbate 1 g i.v. Patient should be kept in bed and as quiet as possible with appropriate symptomatic treatment.

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Dosage

Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours.

  • Follow the directions for using this medicine provided by your doctor.
  • Store this medicine at room temperature between 59 and 86 degrees F (15 and 30 degrees C) in a tightly-closed container, away from heat and light.
  • If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

FOR 2 WEEKS AFTER YOUR LAST DOSE OF THIS MEDICINE, you may have a reaction if you drink alcohol or use a product that contains alcohol. CARRY IDENTIFICATION that states you are taking this medicine.

Additional Information: Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children.

A maximum of 500 mg daily in a single dose should be given for 1 to 2 weeks, preferably taken in the morning. Patients experiencing a sedative effect may take the drug at bedtime or, if necessary, dosage may be adjusted downward.

Average maintenance dose is 250 mg daily (range 125 to 500 mg) but should not exceed 500 mg daily.

NOTE: Some patients, while seemingly on adequate maintenance doses, report that they are able to drink with impunity. Such patients must be presumed to be disposing of their tablets in some manner without actually taking them. Until it has been reliably confirmed that these patients have been taking their daily tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram is ineffective.

Duration of therapy: Daily, uninterrupted administration of disulfiram must be continued until the patient has established a basis for permanent self-control. Depending on the individual patient, maintenance therapy may be required for months or even years.

IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out.

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How Supplied

Each tablet contains: Disulfiram USP 250 or 500 mg.

The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse.

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Antabuse patient information (in plain English)

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