Disulfiram (Oral Route)

1 Disulfiram (Oral Route): A Summary

Brand Name:

Antabuse

Disulfiram is used to help overcome the drinking habit. It inhibits the enzyme aldehyde dehydrogenase probably after conversion into active metabolites. When alcohol is ingested after taking disulfiram, the concentration of acetaldehyde in tissues and blood rises and a number of highly distressing symptoms (aldehyde syndrome) are produced promptly. 

These are –flushing, burning sensation, throbbing headache, perspiration, uneasiness, tightness in chest, dizziness, vomiting, visual disturbances, mental confusion, postural fainting, and circulatory collapse. Duration of syndrome (1-4 hours) depends on the amount of alcohol consumed.

Because of risk of severe reaction, disulfiram is to be used with great caution, only in well-motivated subjects. This drug is not indicated to cure alcoholism, but rather it is preferably used to discourage you from drinking. This drug is available in tablet form only with your doctor's prescription.

2 What to Know Before Using

If you are about to start a drug therapy, the risk-benefit ratio of taking the drug should be considered carefully. Here, the suitable drug therapy is chosen by the doctor with active participation of the patient. 

There are some important factors such as drug interactions, metabolic impairment, hypersensitivity reaction, pregnancy, lactation etc. which may alter the desired therapeutic effects of such medications. 

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. If you have had any allergic reactions to any medicine then you must inform your doctor about that. Further, you should tell your doctor if you have any other medical problems, especially:

Besides, certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects. Moreover, using this medicine with any of the following drugs is not recommended:

  • Amprenavir
  • Anisindione
  • Clozapine
  • Diazepam
  • Dicumarol
  • Fosphenytoin
  • Isoniazid
  • Metronidazole
  • Omeprazole
  • Paraldehyde
  • Phenprocoumon
  • Phenytoin
  • Tinidazole
  • Tranylcypromine
  • Theophylline
  • Warfarin

3 Proper Usage

You should use this medicine following the directions given by your doctor. The dosage schedule and the duration of drug therapy depend on the particular medical problem for which you are using this medicine. The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well.

Disulfiram aversion therapy is indicated in abstinent subjects who sincerely desire to leave the habit. After making sure that the subject has not taken alcohol in the past 12 hours, disulfiram is given orally. 

To help overcome drinking problems, adults and teenagers are advised to take 500 mg or less once a day for one or two weeks at the initial stage. Then, your doctor may lower the dose to 125 to 250 mg once a day. 

Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. However, outdated medicines should be disposed by an appropriate way.

4 Precautions to Take

Firstly, regular visits to your doctor are recommended to check that this medicine is working properly or not. Additionally, you should follow the following guidelines while you are receiving this medicine: 

  • You should avoid alcohol-containing foods, products, or medicines, such as elixirs, tonics, sauces, vinegars, cough syrups, mouth washes, or gargles while taking this drug.
  • Besides, you should not come in contact with or breathe in the fumes of chemicals that may contain alcohol, acetaldehyde, paraldehyde, or other related chemicals, such as paint thinner, paint, varnish, or shellac.
  • Using alcohol-containing products that are applied to the skin, such as rubbing alcohol, back rubs, after-shave lotions, perfumes, or after-bath preparations while you are taking disulfiram may cause headache, nausea, or local redness or itching because the alcohol in these products may be absorbed into your body.
  • Before using alcohol-containing products on your skin, you should test the product first by applying some to a small area of your skin. Allow the product to remain on your skin for 1 or 2 hours. If no redness, itching, or other unwanted effects occur, you can use the product.
  • It is advised not to use any alcohol-containing products on raw skin or open wounds.
  • However, this drug should not be used in patients who are physically dependent on alcohol.

5 Potential Side Effects

Side effects of disulfiram are infrequent; include rashes, metallic taste, nervousness, malaise and abdominal upset. It inhibits a number of other enzymes as well including alcohol dehydrogenase, dopamine β hydroxylase and several cytochrome P450 isoenzymes. Thus, it prolongs the half-life of many drugs. 

Your healthcare professional may advise you about the ways how to prevent or reduce these unwanted side effects. Some unwanted side effects do not need medical attention, that usually go away during the treatment episode as your body adjusts to the medicine. But sometimes you may need to consult with the doctor if you notice any of the following toxic effects:

  • Blurred vision
  • Chest pain or discomfort
  • Confusion
  • Dizziness or fainting
  • Fast or pounding heartbeat
  • Flushing or redness of face
  • Generalized weakness
  • Increased sweating
  • Nausea and vomiting
  • Throbbing headache
  • Troubled breathing
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