Disulfiram (Oral)

Overview

Disulfiram is a drug that has some utility in the treatment of alcoholism when used properly as part of a broader treatment plan. It is important to note that it is not a cure for alcoholism, but rather a temporary deterrent from drinking alcoholic beverages. Its properties as an alcohol antagonist work on a patient by giving them an acute sensitivity to the effects of ethanol in the bloodstream and produces a feeling similar to a hangover in a patient directly after consuming the beverage. As would be expected of a medication of this kind, when compliance with alcohol abstinence is not observed while using this medication it can have the effect of making patients violently ill.

As a therapy for alcoholism, Disulfiram is usually only prescribed in intense cases where multiple attempts to quit drinking have failed. This is because there are certain risks that come with the use of the drug in the case when the patient will not be deterred. Use of alcohol with Disulfiram can be extremely dangerous especially in patients who are already in poor cardiovascular health. In addition, there are significant risks associated with some of its more serious side effects and interactions with other drugs. For these reasons, it is best used when part of a more comprehensive treatment plan aimed at building and maintaining sobriety rather than simply deferring alcohol use.

Condition treated:

  • Alcoholism

Type Of Medicine

  • Alcohol Antagonist

Side Effects

Disulfiram has a number of side effects associated with it which may be experienced in addition to its intended effects of inducing illness upon consumption of alcohol. Some of these side effects may require medical attention if they are experienced. Consultation with a doctor should be sought out if any of these side effects happen even without consuming alcohol.

Some of the less common side effects of Disulfiram include pain in the eyes, changes in vision, changes to mood, or feelings of numbness in the extremities. Patients may also feel weak or experience unexplained pain while taking this drug. Rarely, patients can notice a yellowing of their eyes or skin often accompanied by a darkening of the urine and light/gray stools. This rare condition can also be experienced with a severe pain in the stomach or abdomen.

While the previous side effects are quite serious, there are also some which are considered routine and may subside as the body gets used to taking the medication after a short period of time. Your physician may have more information on how to alleviate these temporary side effects and for how long they may be expected to persist. If they continue after this short adjustment period or if they are more intense than expected a doctor should be informed as this may indicate a more serious health problem.

Common temporary side effects associated with taking Disulfiram include an immediate drowsiness upon taking the medicine which is similar to that experienced when taking certain cold medicines or allergy medications. Rarely, patients will experience a broader range of debilitating temporary side effects such as headaches, unusual fatigue, and a strange metallic taste in the mouth. Some rare cases of erectile dysfunction or other sexual ability disorders have been experienced by male patients. Additionally, some patients have complained of a temporary skin rash when beginning to take Disulfiram. If any other side effects occur then they may be a result of an interaction with an additional substance or an allergic reaction to the medication. Seek out medical attention if this is the case as the results of these symptoms can be unpredictable.

Dosage

When taking this medication the most important thing to do is observe the strict prohibition on taking it within 12 hours of drinking any alcoholic beverage or medicine that includes alcohol as an active or inactive ingredient. In addition, there are some foods that will need to be avoided prior to taking the dose. Certain sauces and vinegar-based foods are a common source of unintended alcohol consumption. Carefully read all ingredient labels when using this medication. Before taking this medication for the first time, it may be a good idea to only drink water for the 12 hours previous to that first dose. This medication should only be taken as indicated by a doctor and neither the amount of the dose or the timing of the dose should be altered to accommodate the drinking of alcoholic beverages. While this will normally require a morning dose, if the side effect of drowsiness is experienced then this can be adjusted to a dose before bedtime in order to avoid daytime complications. The dosage prescribed by your doctor may vary based on general health, weight, duration of the dosage, or any number of other factors. Do not alter your dose based on the information here, but rather follow the usage guidelines on your prescription.

When taken as an oral dose of tablets to combat alcoholism, Disulfiram should be taken as a 500mg dose once per day. This should be observed for two weeks, after which the dose may be decreased gradually to 250mg daily. While this medication is generally not recommended for use by children under 12, it may be prescribed under the guidelines determined by a pediatrician.

Interactions

The most common drug interactions with Disulfiram is its intended use of poorly interacting with alcohol. However, it is also known to interact poorly with other medications including those listed below. Use of this drug with any of the medications listed below is not recommended and in the case of concurrent prescriptions your doctor may discontinue or change the dose of one or both of them to ensure that these interactions aren't experienced. Make sure that your doctor is informed of all drugs you are taking which may be on this list.

  • Amprenavir
  • Dronabinol
  • Metronidazole
  • Paraldehyde

While using the following medications may not be recommended they may be necessary based on the conditions that are treated. However, use of Disulfiram should only be used with care.

  • Clozapine
  • Secnidazole
  • Tinidazole
  • Tranylcypromine

The following medication may come with a risk of significant side effects. However, they may represent the best possible treatment for a specific disorder or there may be no other alternatives. Your doctor may change one or both doses or the time of day the medication is taken based on this condition.

  • Isoniazid
  • Warfarin
  • Diazepam
  • Omeprazole
  • Phenprocoumon
  • Phenytoin
  • Theophylline
  • Dicumarol
  • Fosphenytoin
  • Anisindione

The biggest precaution that should be observed when using Disulfiram is ensuring that it is not taken within 12 hours of drinking alcohol, but the effects that it has when combined with alcohol can be experienced when using products other than alcoholic beverages. Common over-the-counter medications can contain alcohol as an active or inactive ingredient and some foods can as well. Carefully read the ingredients of all food and drink that is consumed as even a small amount of ethanol can trigger the adverse reaction intended by taking this medication.

Some medical problems that a patient has or those that have been experienced in their medical history may affect the decision of a doctor to prescribe Disulfiram for the purpose of treating alcohol abuse. If there is a history of these conditions or any symptoms associated with them arising, inform your medical care provider immediately. In some cases, the drug may make these conditions worse or the condition may interfere with the drug working as it is intended.

  • Underactive thyroid
  • Depression
  • Heart or blood vessel disease
  • Asthma
  • Lung disease
  • Seizure disorder
  • Kidney disease
  • Liver disease
  • Severe mental illness
  • Diabetes
  • Epilepsy
  • Skin allergy

Warnings

Disulfiram has a risk of allergic reaction in certain patients. Patients should let their doctor know about any allergies that they have experienced in their lifetime as it may be indicative of a potential allergy to this medication. Alcohol should not be consumed 12 hours before or after taking Disulfiram even in the most minute amounts. There is a risk of severe illness associated with drinking alcohol within 14 days of taking this medication, so care should be taken to closely inspect the ingredients of any food or drink that is consumed for this two week period. Common household products may also contain alcohol that will induce a violent illness in someone who is taking Disulfiram, such as mouthwash or over-the-counter cough syrup. Common food additives such as sauces and vinegar may contain a sufficient amount of ethanol to pose a risk as well.

Alcohol does not necessarily need to be ingested to cause this reaction. Inhaling the fumes of certain chemicals containing alcohol such as paint thinner or varnish has been known to cause illness, as has the application of certain products to the skin such as bathing products, aftershave, cologne, rubbing alcohol and transdermal medication patches. Absorption of alcohol into the body in this manner may cause a local redness accompanied by severe itching. This may also be accompanied by some of the symptoms of a hangover including headaches and nausea. To avoid this potential interaction, any such products should be tested on the skin before being considered for regular use. Applying a minute amount to the skin and allowing it to remain on the skin for up to 2 hours should be sufficient to observe if adverse effects occur. If an injury occurs that results in bleeding or open wounds while using Disulfiram, inform any medical personnel or first responders not to use isopropyl alcohol or any other alcohol product near open wounds or injection sites.

Failure to observe the prohibition against consuming alcohol while using this medication can pose serious health risks. The effects that can occur when drinking alcohol during a Disulfiram regimen include the following symptoms:

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

These symptoms can range in severity from those experienced during a normal hangover to those that are experienced during a serious alcohol overdose. They may last as little as half an hour or persist for several hours. In severe cases where the reaction is stronger than normal or a large amount of alcohol has been consumed, the drug can induce fatal reactions such as seizures or heart failure. If the patient loses consciousness during this reaction there is a risk of asphyxiation as a result of vomiting while unconscious.

As a result of these risks, the prescribing physician may require a patient to carry an identification card while taking Disulfiram. This will not only inform the carrier of potential symptoms that may occur as a result of the use of alcohol products but inform medical personnel that the patient is taking Disulfiram if they are found unconscious. This card should also be shown before receiving any routine medical services or having any dental procedure performed as common medical products and anesthetics can react with Disulfiram or result in a significantly enhanced effect.

A typical side effect of taking Disulfiram is a sudden feeling of drowsiness and loss of alertness. Until a patient knows how they will be affected by this medication they should refrain from driving or operating machinery as well as any activity that may be dangerous with reduced attention.

Storage

The guidelines for storing most kinds of medications that take the form of a tablet apply when storing Disulfiram. The tablets should be stored in the container that they came in or another approved secure container. The container should be stored at room temperature and away from adverse environmental conditions such as excessive moisture, heat sources, and direct sunlight. The medication should not be refrigerated or frozen. Keep this and all prescription medications secure and away from the reach of children or pets. When expired or no longer needed, the prescription of Disulfiram should be disposed of in accordance with local guidelines regarding the disposition of medical waste. Ask your doctor or pharmacist if you have any questions about how to dispose of medication in your area.

Summary

While many medicines make patients feel better and alleviate their suffering, Disulfiram functions by making a patient feel worse. When mixed with alcohol, the drug induces a build-up of acetaldehyde by breaking a crucial process in how the body metabolizes alcohol. This is instantly realized in the most unpleasant effects of a hangover and is meant as a deterrent to the enjoyment of alcohol. Nonetheless, there is still a high degree of noncompliance among patients taking Disulfiram and continuing to drink alcohol while taking it can have severe consequences.

It is important to note that Disulfiram is not a cure for alcoholism and should not be prescribed as such. As a result of the risks posed by the use of Disulfiram, it is normally only prescribed by a doctor when multiple other attempts at quitting have already been tried and failed. With only a moderate amount of adverse side effects possible, it is usually considered safe to use so long as alcohol is actively abstained from while using the drug. When used properly and when it functions as a sufficient reason for a patient to disrupt their drinking habits, it can be a valuable aid for a more comprehensive approach to the physical and psychological treatment of alcoholism.