DISULFIRAM
(dye-sul'fi-ram)
Antabuse, Cronetal, Ro-sulfiram
Classifications: enzyme inhibitor; antialcohol agent
Pregnancy Category: X

Availability

250 mg, 500 mg tablets

Actions

Acts as a deterrent to alcohol ingestion by inhibiting the enzyme acetaldehyde dehydrogenase, which normally metabolizes alcohol in the body.

Therapeutic Effects

When a small amount of alcohol is ingested, a complex of highly unpleasant symptoms known as the disulfiram reaction occurs, which serves as a deterrent to further drinking.

Uses

Adjunct in treatment of the patient with chronic alcoholism who sincerely wants to maintain sobriety.

Contraindications

Severe myocardial disease; psychoses; pregnancy (category X), lactation; patients who have recently ingested alcohol, metronidazole, paraldehyde; multiple drug dependence.

Cautious Use

Diabetes mellitus; epilepsy; hypothyroidism; coronary artery disease, cerebral damage; chronic and acute nephritis; hepatic cirrhosis or insufficiency; abnormal EEG.

Route & Dosage

Alcoholism
Adult: PO 500 mg/d for 1–2 wk, then 125–500 mg/d (max: 500 mg/d)

Administration

Oral

Adverse Effects (1%)

Reaction with alcohol ingestion: Flushing of face, chest, arms, pulsating headache, nausea, violent vomiting, thirst, sweating, marked uneasiness, confusion, weakness, vertigo, blurred vision, pruritic skin rash, hyperventilation, abnormal gait, slurred speech, disorientation, confusion, personality changes, bizarre behavior, psychoses, tachycardia, palpitation, chest pain, hypotension to shock level arrhythmias, acute congestive failure. Severe reactions: Marked respiratory depression, unconsciousness, convulsions, sudden death. Body as a Whole: Hypersensitivity (allergic or acneiform dermatitis; urticaria, fixed-drug eruption). CNS: Drowsiness, fatigue, restlessness, headache, tremor, psychoses (usually with high doses), polyneuritis, peripheral neuropathy, optic neuritis. GI: Mild GI disturbances, garlic-like or metallic taste, hepatotoxicity, hypersensitivity hepatitis.

Diagnostic Test Interference

Disulfiram can reduce uptake of I131; or decreases PBI test results (rare).

Interactions

Drug: Alcohol (including in liquid OTC drugs, IV nitroglycerin, IV cotrimoxazole), metronidazole, paraldehyde will produce disulfiram reaction; isoniazid can produce neurological symptoms; may increase blood levels and toxicity of warfarin, paraldehyde, barbiturates, phenytoin.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Onset: Up to 12 h. Duration: Up to 2 wk. Distribution: Initially deposited in fat. Metabolism: Metabolized slowly in liver. Elimination: 5–20% excreted in feces; 20% remains in body for 1–2 wk; some may be excreted in breath as carbon disulfide.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug