Pharm

Antabuse

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Antabuse, Disulfiram

  • Background
  1. Used since 1951
  • Mechanism
  1. Buildup of acetaldehyde if drinks on Disulfiram, with secondary severe reaction
  2. Taking Antabuse seals daily sobriety contract
    1. Today they will not drink
  3. Does not reduce Alcohol craving
  • Efficacy
  1. No better than Placebo in most studies
  2. May have better efficacy when administered under close supervision
  • Contraindications
  1. Concurrent use of medications with Drug Interaction
    1. Metronidazole (Flagyl)
    2. Medication containing Alcohol (e.g. some Inhalers)
  2. Age over 60 years
  3. Comorbid illness
    1. Cirrhosis with Portal Hypertension
    2. Coronary Artery Disease
    3. Chronic Renal Failure
    4. Diabetes Mellitus
    5. Peripheral Neuropathy
    6. Seizure Disorder
    7. Severe respiratory disease
  4. Prior Psychosis on Antabuse
  • Drug Interactions
  1. See contraindications above for other interactions
  2. Medications that raise Antabuse levels
    1. SSRI
    2. Tricyclic Antidepressants
    3. Dilantin
    4. Coumadin
    5. Isoniazid
    6. Unsteady gait
  • Adverse Effects
  • Symptoms and Signs of Antabuse with Alcohol reaction
  1. Headache
  2. Nausea and Vomiting
  3. Large red hot pruritic rash
  4. Shortness of Breath
  5. Cardiac Arrest
  6. Seizure
  7. Coma
  8. Death
  • Adverse Effects
  • Antabuse alone
  1. Fatigue (resolves after 2-3 weeks)
  2. Garlic breath
  3. Metallic Taste
  4. Acne (Treat with non-Alcohol based Comedolytic)
  5. Rare neurologic sequelae
  6. Rare hepatotoxicity
  7. Peripheral Neuropathy (or neuritis)
  • Management
  • Alcohol-Antabuse reaction
  1. Benadryl 50 mg IM
    1. Give additional Benadryl for home
  • Labs (consider, done by some clinicians)
  1. Liver Function Tests
    1. Baseline, 2 weeks, 3 months and then every 6 months
  • Dose
  1. Antabuse 250 mg orally daily (may be increased up to 500 mg daily)
  2. Do not start for at least 12 hours from last Alcohol intake
  • Precautions
  1. Counsel: life threatening risk Alcohol and Antabuse
  2. If choosing to drink, wait 14 days after last Antabuse
  3. Alcohol-Antabuse reactions occur at low Alcohol levels
  4. Do not use Flagyl with Antabuse
  5. Read Labels: Alcohol is in many products!
    1. Flavoring in frosting
    2. Sauces
    3. Wine Vinegar (14% Alcohol)
    4. Aerosol propellant (Hair spray)
    5. Skin absorption
      1. Alcohol swab on lab draw
      2. Hand lotion
      3. Soap
    6. Gel toothpaste
    7. Mouthwash
    8. Cough lozenge, Cough medications
    9. Nyquil (35% Alcohol)
  6. Every patient must have a medic alert card
    1. Alerts that patient is in on Antabuse
    2. Do not give Alcohol, paraldehyde or related product
  7. Every patient should sign a witnessed consent
  8. Patient Education handouts are highly recommended
  9. Document that the above has been reviewed with patient
  • Safety
  1. Pregnancy Category C
  2. Lactation: Unknown
  • Cost
  1. Cost: $190/month trade name (but generic available for $50 per month)
  • References
  1. Mason (2001) J Clin Psychiatry 62:42-8 [PubMed]
  2. Winslow (2016) Am Fam Physician 93(6): 457-65 [PubMed]