DISULFIRAM

Indications & Dose:

As an aid in the management of selected chronic alcoholic patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage. Used alone, without proper motivation and without supportive therapy, disulfiram is not a cure for alcoholism, and it is unlikely that it will have more than a brief effect on the drinking pattern of the chronic alcoholic.

DOSAGE Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours. A maximum of 500 mg daily in a single dose should be given for 1 to 2 weeks, preferably taken in the morning. Patients experiencing a sedative effect may take the drug at bedtime or, if necessary, dosage may be adjusted downward. Average maintenance dose is 250 mg daily (range 125 to 500 mg) but should not exceed 500 mg daily.

NOTE: Some patients, while seemingly on adequate maintenance doses, report that they are able to drink with impunity. Such patients must be presumed to be disposing of their tablets in some manner without actually taking them. Until it has been reliably confirmed that these patients have been taking their daily tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram is ineffective.

Duration of therapy: Daily, uninterrupted administration of disulfiram must be continued until the patient has established a basis for permanent self-control. Depending on the individual patient, maintenance therapy may be required for months or even years.

Contraindications:

Patients who are receiving or have recently received metronidazole, paraldehyde, alcohol, or alcohol containing preparations such as cough syrups, elixirs, should not be given disulfiram. Severe myocardial disease or coronary occlusion; diabetes mellitus; hepatic cirrhosis or insufficiency; hypothyroidism; epilepsy; cerebral damage; chronic and acute nephritis; psychoses; and hypersensitivity to disulfiram or other thiuram derivatives used in the manufacture of items such as pesticides or vulcanized rubber

Side Effects:

Cautions:

Precautions:

Avoid Alcohol, alcohol found in sauces, vinegar, mouthwash, liquid medicines, lotions, after shave, or backrub products. A reaction to alcohol may cause flushing, nausea, thirst, abdominal pain, chest pain, dizziness, vomiting, fast breathing, fast heartbeat, fainting, difficult breathing, or confusion. Use caution when using topical products containing alcohol, such as cologne or perfume. Before using alcohol-containing products on the skin, test the product by applying some to a small area of the skin. If no redness, itching, headache, or nausea occur after 1 to 2 hours, you should be able to use the product

Pregnancy and Nursing: It is not known whether disulfiram can cause fetal harm when administered during pregnancy, but one report of limb reduction anomalies in infants born to disulfiram-treated mothers has been published. Because of these findings, extreme care should be exercised before administering disulfiram during pregnancy. It is not known whether this drug is excreted in human milk. Since many drugs are, and because of the potential for serious adverse reactions in the nursing infants, before administering disulfiram to a nursing mother it would appear advisable to discontinue nursing

Interaction:

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Optic neuritis, peripheral neuritis, polyneuritis may occur following administration of disulfiram. Multiple cases of both cholestatic and fulminant hepatitis have been reported following administration of the drug. Occasional skin eruptions have been reported. In a small number of patients, a transient mild drowsiness, fatigue, impotence, headache, acneiform eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may be experienced during the first 2 weeks of therapy. These complaints usually disappear later during therapy or with reduced dosage. Psychotic reactions have been noted, in most cases attributable to high dosage, associated toxicity with other drugs (metronidazole or isoniazid), or the unmasking of underlying psychoses in patients stressed by withdrawal of alcohol.

Patient And Carer Advice: