Disulfiram
tablets

Generic Name:
Disulfiram
Drug description:
Each tablet contains 200 mg disulfiram.
Presentation:
Tablet
Indications:
Alcohol deterrent compound. Disulfiram may be indicated as an adjuvant in the treatment of carefully selected and co-operative patients with drinking problems. Its use must be accompanied by appropriate supportive treatment.
Adult Dosage:

Adults and elderly patients only:
It is recommended that treatment with Disulfiram should be initiated only in a hospital or specialised clinic and by physicians experienced in its use. The patient should have adequate social and family support to avoid ingestion of alcohol. Suitable patients should not have ingested alcohol for at least 24 hours and must be warned that a Disulfiram-alcohol reaction is potentially dangerous.
On the first day of treatment, the patient should be given no more than 4 tablets of Disulfiram in one dose (800 mg). The next day the patient should take 3 tablets followed on the third day by 2 tablets and on the fourth and fifth days by 1 tablet. Subsequently, daily dosing should continue at 1 or half a tablet daily for as long as advised by the physician but no longer than six months without review. In the routine management of the alcoholic it is not recommended to carry out an alcohol challenge test. If the clinician feels an alcohol challenge test is essential for the success of the therapy, full information of the procedure and risks of this test can be obtained from the company. As severe reactions can occur any alcohol challenge should be carried out in specialised units by physicians acquainted with the procedure. Full resuscitation facilities must be immediately available.
Child Dosage:
Not recommended.
Contra Indications:
Presence of cardiac failure, coronary artery disease, previous history of CVA, hypertension, severe personality disorder, suicidal risk or psychosis.
Special Precautions:
Caution should be exercised in the presence of renal failure, hepatic or respiratory disease, diabetes mellitus and epilepsy. Before initiating treatment it is advised that appropriate examinations should be carried out to establish the suitability of the patient for treatment. Patients must not ingest alcohol during or for 1 week after ceasing Disulfiram therapy. Patients must be warned of the unpredictable and potentially severe nature of a Disulfiram-alcohol reaction as, in rare cases deaths have been reported following the drinking of alcohol by patients receiving Disulfiram. Certain foods, liquid medicines, remedies, tonics, toiletries, perfumes and aerosol sprays may contain sufficient alcohol to elicit a Disulfiram-alcohol reaction and patients should be made aware of this. Caution should also be exercised with low alcohol and “non-alcohol” or “alcohol-free” beers and wines, which may provoke a reaction when consumed in sufficient quantities. All personnel involved in the administration of Disulfiram to the patient know that Disulfiram should not be given during a drinking episode.
Interactions:
Disulfiram blocks the metabolism of alcohol and leads to an accumulation of acetaldehyde in the blood stream. The Disulfiram-alcohol reaction can occur within 10 minutes of ingestion of alcohol and may last several hours. It is characterised by intense flushing, dyspnoea, headache, palpitations, tachycardia, hypotension, nausea and vomiting.
Supportive therapy should be available and measures may be necessary to counteract hypotension. Severe vomiting might occur requiring administration of intravenous fluids.
Disulfiram may potentiate the toxic effects of warfarin, antipyrine, phenytoin, chlordiazepoxide and diazepam by inhibiting their metabolism. Animal studies have indicated similar inhibition of metabolism of pethidine, morphine and amphetamines. A few case reports of increase in confusion and changes in affective behaviour have been noted with the concurrent administration of metronidazole, isoniazid or paraldehyde. Potentiation of organic brain syndrome and choreoatphetosis following pimozide have occurred very rarely. The intensity of the Disulfiram-alcohol reaction may be increased by amitriptyline and decreased by diazepam. Chlorpromazine while decreasing certain components of the Disulfiram-alcohol reaction may increase the overall intensity of the reaction. Disulfiram inhibits the oxidation and renal excretion of rifampicin.
Adverse Reactions:
During initial treatment, drowsiness and fatigue may occur, nausea, vomiting, halitosis and reduction in libido have been reported. If side effects are marked the dosage may be reduced. Psychotic reactions, including depression, paranoia, schizophrenia and mania occur rarely in patients receiving Disulfiram. Allergic dermatitis, peripheral neuritis and hepatic cell damage have also been reported