Disulfiram (Antabuse)

Question 1

Brand

Answer 1

Antabuse

Question 2

Use

Answer 2

Maintenance of alcohol abstinence

Question 3

MOA

Answer 3

Irreversible inhibition of aldehyde dehydrogenase.

Toxic levels of acetaldehyde build up if patient drinks - unpleasant S/Es - cause negative conditioning

Question 4

how long until it works

Answer 4

Immediate effect. Don’t take until 12 hours after drinking.

Question 5

Tests

Answer 5

Baseline and follow up LFTs

Question 6

S/Es

Answer 6

• Metallic taste (carbon disulfide, a metabolite of disulfiram, is excreted through lungs)
• Dermatitis, Sedation
• Flushing, Headache, Tachycardia, N/V on drinking
• Hepatotoxic
• MI, CHF, resp depression if drinking

Question 7

Dosing

Answer 7

• 250-500 mg/day; 1 year duration
• Oral tablet 250 mg or 500 mg
• Don’t take until 12 hours after drinking
• Take in morning
• If sedation occurs, take at night
• Start at 250-500 mg/day, maintenance 250 mg, max 500 mg

Question 8

OD, long term use till, how to stop, taper or not

Answer 8

• OD unknown
• Use until pt recovered
• No need to taper
• warn pt of disulfiram reaction upto 2 weeks after stopping

Question 9

Half life of parent drug

Answer 9

60-120 hours

Question 10

Half life of metabolites

Answer 10

13. 9 hours for diethyldithiocarbamate

8. 9 hours for carbon disulfide

Question 11

Drug interactions

Answer 11

• increase blood levels of PHENYTOIN (take baseline and follow up levels of phenytoin)
• Prolong PT (need anticoagulant dose adjustment)
• Use with ISONIAZID - unsteady gait or mental status changes

Question 12

Precautions

Answer 12

• Don’t use if patient intoxicated
• Don’t give without patient’s full knowledge
• Not recommended in pts over 60 years
• Not recommended in severe lung disease, chronic renal failure, diabetes, peripheral neuropathy, seizures, cirrhosis, portal HTN
• Use with extreme caution in hypothyroidism, epilepsy, cerebral damage
• pt should not be exposed to ethylene dibromide or its vapors

Question 13

C/I

Answer 13

• Don’t use if patient intoxicated
• Don’t give without patient’s full knowledge
• Don’t take until 12 hours after drinking
• pt taking metronidazole, amprenavir, ritonavir, sertraline
• psychosis pt
• Cardiovascular dis
• Allergy to disulfiram or thiuram

Question 14

Special populations

Answer 14

• Don’t use in chronic cardiovascular, hepatic or renal failure pt
• Not recommended in pts over 60 years
• Not recommended in pregnancy and BF pts

Question 15

Advantage

Answer 15

People motivated to quit drinking

Question 16

disadvantage

Answer 16

low adherence rate

Question 17

Of note

Answer 17

• Some efficacy in comorbid alcohol use and PTSD

* Some evidence in cocaine dependence use