23 Nov 2009
Antabuse (disulfiram) is a prodrug.
Absorption of disulfiram from the gastrointestinal tract is rapid but incomplete and approximately 20% is excreted in the faeces. Because of its high lipid solubility, disulfiram is widely distributed and accumulated in various fat depots. Disulfiram is rapidly metabolised to diethyldithiocarbamate (DDC), which is partly excreted as carbon disulfide in the expired air and is partly metabolised in the liver to Me-DDC. Me-DDC is metabolised further to the active metabolite Me-DTC (diethylthiocarbaminic acid methyl ester). The concentration of Me-DTC reaches its maximum after about four hours, but the maximum enzyme inhibiting effect (aldehyde dehydrogenase (ALDH)) is first reached after three daily doses. The plasma half-life for Me-DTC is about ten hours, but the enzyme inhibiting effect of ALDH lasts considerably longer. The effect can thus persist for 7 to 14 days after discontinuation. In patients receiving disulfiram maintenance treatment, the ingestion of alcohol brings about a typical disulfiram-alcohol reaction within the course of five to ten minutes. Metabolism is not appreciably affected by a mild to moderate decrease in hepatic function. The metabolites are chiefly excreted with the urine. A part is recovered in the expired air as carbon disulfide.
Up to 20% of a dose may remain in the body for one week or longer.
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