disulfiram

Drug Name

Generic Name : disulfiram

Brand Name: Antabuse

Classification: Antialcoholic drug, Enzyme inhibitor

Pregnancy Category C

Dosage & Route

Available forms : Tablets—250 mg.

BLACK BOX WARNING: Never administer to an intoxicated patient or without patient’s knowledge. Do not administer until patient has abstained from alcohol for at least 12 hr.

ADULTS

  • Initial dosage: Administer maximum of 500 mg/day PO in a single dose for 1–2 wk. If a sedative effect occurs, administer at bedtime or decrease dosage.
  • Maintenance regimen: 125–500 mg/day PO. Do not exceed 500 mg/day. Continue use until patient is fully recovered socially and a basis for permanent self-control is established.
  • Trial with alcohol (do not administer to anyone > 50 yr): After 1–2 wk of therapy with 500 mg/day PO, a drink of 15 mL of 100 proof whiskey or its equivalent is taken slowly. Dose may be repeated once, if patient is hospitalized and supportive facilities are available.
Therapeutic actions
  • Disulfiram inhibits aldehyde dehydrogenase, the oxidative enzyme of acetaldehyde, a metabolite of alcohol. The latter is accumulated in the blood, thus producing unpleasant symptoms of disulfiram-alcohol reaction when a patient has taken small amounts of alcohol.
Indications
  •  Aids in the management of selected chronic alcoholics who want to remain in a state of enforced sobriety
Adverse effects
  • Drowsiness, fatigue, lassitude, psychotic reactions, peripheral and optic neuropathies, hepatotoxicity, garlic-like or metallic after-taste, GI upset, body odour, bad breath, headache, impotence.
  • Potentially Fatal: Respiratory depression, CV collapse, arrhythmias, myocardial infarction, acute CHF, convulsions, sudden death.
Contraindications
  • Hypersensitivity, CVS diseases; peripheral neuropathy, psychosis. Not to be used in patients with alcohol intoxication.
Nursing considerations
Assessment
  • History: Allergy to disulfiram or other thiuram derivatives; severe myocardial disease or coronary occlusion; psychoses; current or recent treatment with metronidazole, paraldehyde, alcohol, alcohol-containing preparations (eg, cough syrups, tonics); diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or impairment; pregnancy
  • Physical: Skin color, lesions; thyroid palpation; orientation, affect, reflexes; P, auscultation, BP; R, adventitious sounds; liver evaluation; LFTs, renal function tests, CBC, SMA-12
Interventions
  • Do not administer until patient has abstained from alcohol for at least 12 hr.
  • Administer orally; tablets may be crushed and mixed with liquid beverages.
  • Monitor liver function tests before, in 10–14 days, and every 6 mo during therapy to evaluate for hepatic impairment.
  • Monitor CBC, SMA-12 before and every 6 mo during therapy.
  • Inform patient of the seriousness of disulfiram-alcohol reaction and the potential consequences of alcohol use. Disulfiram should not be taken for at least 12 hr after alcohol ingestion and a reaction may occur up to 2 wk after disulfiram therapy is stopped; all forms of alcohol must be avoided.
  • Arrange for treatment with antihistamines if skin reaction occurs.
  • WARNING: Institute supportive measures if disulfiram-alcohol reaction occurs; oxygen, carbon dioxide combination, massive doses of vitamin C IV, ephedrine have been used.
Teaching points
  • Take drug daily; if drug makes you dizzy or tired, take it at bedtime. Tablets may be crushed and mixed with liquid.
  • Abstain from forms of alcohol (beer, wine, liquor, vinegars, cough mixtures, sauces, aftershave lotions, liniments, colognes, liquid medications). Using alcohol while taking this drug can cause severe, unpleasant reactions—flushing, copious vomiting, throbbing headache, difficulty breathing, even death.
  • Wear or carry a medical ID while you are taking this drug to alert any medical emergency personnel that you are taking it.
  • Have periodic blood tests while taking drug to evaluate its effects on the liver.
  • You may experience these side effects: Drowsiness, headache, fatigue, restlessness, blurred vision (use caution driving or performing tasks that require alertness); metallic aftertaste (transient).
  • Report unusual bleeding or bruising, yellowing of skin or eyes, chest pain, difficulty breathing, ingestion of any alcohol.