Disulfiram

What is Disulfiram (Antabuse)

Disulfiram is a supportive treatment option that acts as a deterrent from drinking alcohol and is available as a generic formulation as well as the Antabuse brand. When you drink alcohol, it is changed in the body into acetaldehyde, Disulfiram blocks the enzyme which breaks down acetaldehyde. This leads to an increased level of acetaldehyde in the blood causing unpleasant physical reactions.

You must not drink any alcohol with Disulfiram (and for up to 14 days after the end of treatment). It will make you feel unwell and is potentially dangerous. If you drink even a small amount of alcohol with Disulfiram it will produce extremely unpleasant physical reactions known as Disulfiram tablet-alcohol reaction.

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It will give you a throbbing headache, a flushed face, increased body temperature, sweating, nausea, itchy skin or rash, anxiety, dizziness, headache, blurred vision, and the sensation of having a “thumping heart” (palpitations). This reaction starts within about 15 minutes of drinking alcohol and can last for several hours. The reaction is unpredictable, and symptoms may be severe or life-threatening.

In severe cases, rapid heartbeat, low blood pressure, abnormally slow breathing, chest pain, abnormal heart rhythm, coma or fits may occur. Knowing this will happen will stop you drinking alcohol. Due to these potentially dangerous reactions, Disulfiram is only prescribed to people who are determined to stay off alcohol.

Make sure your family and friends know the importance of you abstaining from alcohol, so that they can support you. Caution should be exercised with low alcohol and “non-alcoholic” or “alcohol-free” beers and wines. If enough is taken they may produce Disulfiram tablet-alcohol reaction.

If you experience any symptoms of a Disulfiram tablet-alcohol reaction mentioned above, ensure you seek urgent medical attention.

How should I take Disulfiram?

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Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

It is important that you have not drunk alcohol for at least 24 hours before taking the first dose. Swallow the tablets with water.

• Day one: four tablets (800mg)
• Day two: three tablets (600mg)
• Day three: two tablets (400mg)
• Days four and five: one tablet
• Day six onwards: ½ to one tablet (100 mg-200 mg) a day for as long as directed by your responsible clinician.

The tablet can be divided into equal halves.

What if I forget to take a dose?

If forget to take a dose, take it as soon as you remember if it is within 12 hours of when the dose was due. If you do not remember until more than 12 hours later, skip the missed dose. Do not take two doses together to make up for a forgotten dose.

How much food do I take with Disulfiram?

Swallow tablet(s) with water.

Certain foods, liquid medicines, remedies, tonics, toiletries, mouthwashes, perfumes, and sprays may contain enough alcohol to cause a Disulfiram tablet-alcohol reaction. Caution should also be exercised with low alcohol and “non-alcoholic” or “alcohol-free” beers and wines. If enough is taken they may produce unpleasant reactions.

What are the common side effects with Disulfiram?

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Disulfiram, like all other medicines, has some side effects. Most are minor and will settle down within a few days or weeks. Side effects include feeling tired or sleepy, vomiting, nausea, bad breath, and decreased libido. Further information is available in the manufacturer’s printed information leaflet which is inside the medication pack.

If you experience any side effects, and either they are troubling you or you develop any new symptoms after you start Disulfiram, tell your doctor, nurse or pharmacist who will tell you what to do.

If you experience any symptoms of a Disulfiram tablet-alcohol reaction mentioned above, ensure you seek urgent medical attention.

What medicines should I avoid with Disulfiram?

It is important to tell your doctor, nurse and pharmacist of other medications (including over-the-counter medication) you are taking, and any new medication(s) started while you are on treatment to ensure they are compatible with Disulfiram. It is also important to inform them if you have had any previous allergic reaction(s) to medication.

Even a very small amount of alcohol can cause a reaction and certain medicines such as cough mixtures contain alcohol. You will need to check such items. The symptoms (as outlined above) may include flushing, nausea, palpitations and, more seriously, arrhythmias, hypotension and collapse.

Tell your doctor, nurse or pharmacist if you are taking, have recently taken, or might take any other medicines, including those taken without a prescription. Especially:

• Warfarin (reduces blood clotting)
• Phenytoin and paraldehyde (to treat epilepsy)
• Theophylline (to treat asthma or COPD)
• Benzodiazepines such as Chlordiazepoxide and Diazepam (to treat anxiety)
• Pethidine and Morphine (painkillers)
• Amphetamines (stimulants)
• Primozide and Chlorpromazine (to treat mental illness)
• Isoniazid, metronidazole, rifampicin (to treat infections)
• Amitriptyline (to treat depression)

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