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Antabuse Side Effects

Generic Name: disulfiram

Note: This page contains information about the side effects of disulfiram. Some of the dosage forms included on this document may not apply to the brand name Antabuse.

Not all side effects for Antabuse may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to disulfiram: oral tablet

In addition to its needed effects, some unwanted effects may be caused by disulfiram (the active ingredient contained in Antabuse). In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking disulfiram, check with your doctor or nurse as soon as possible:

Less common
  • Eye pain or tenderness or any change in vision
  • mood or mental changes
  • numbness, tingling, pain, or weakness in hands or feet
Rare
  • Darkening of urine
  • light gray-colored stools
  • severe stomach pain
  • yellow eyes or skin

Some of the side effects that can occur with disulfiram may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Drowsiness
Less common or rare
  • Decreased sexual ability in males
  • headache
  • metallic or garlic-like taste in mouth
  • skin rash
  • unusual tiredness

For Healthcare Professionals

Applies to disulfiram: oral tablet

Other

Disulfiram inhibits the metabolism of acetaldehyde, a breakdown product of alcohol. Acetaldehyde formation is at least partially responsible for the reaction. The "disulfiram (the active ingredient contained in Antabuse) reaction" generally occurs within 15 minutes of ingestion of alcohol and persists as long as alcohol is present in the system. Death has rarely been reported, generally when higher dosages are given. Patients should not receive disulfiram until 12 hours after any alcohol ingestion. Disulfiram reactions may occur up to two weeks after disulfiram has been discontinued.[Ref]

The ingestion of alcohol in patients pretreated with disulfiram generally results in an unpleasant reaction referred to as a "disulfiram reaction". Elements of this reaction may include any of the following: flushing, throbbing in the head and neck, headache, nausea, vomiting, sweating, thirst, chest pain, palpitations, dyspnea, hyperventilation, tachycardia, confusion, arrhythmias, and convulsions.[Ref]

Hepatic

Disulfiram-induced hepatitis has been confirmed by rechallenge in several cases. The development of hepatitis has been reported to occur within 2 weeks to several months of beginning disulfiram (the active ingredient contained in Antabuse) Liver biopsy frequently demonstrates fibrosis, liver cell necrosis, eosinophilic infiltrates, and portal inflammation. Disulfiram-induced hepatitis appears to be due to hypersensitivity, although extrahepatic signs of hypersensitivity are not always apparent. Baseline liver function tests should be obtained and monitored periodically during the first several months of therapy. In addition, patients should be educated about the symptoms of hepatitis. Disulfiram therapy should be discontinued promptly if liver function deteriorates.[Ref]

Hepatic side effects have included cases of acute hepatitis accompanied by fatigue, malaise, anorexia, nausea, abdominal pain, and jaundice. Although hepatic function has returned to normal over several weeks in some patients, liver failure and death has also been reported.

Subcutaneous deposits of carotene which simulate jaundice has been reported in a 55-year-old man who presented with yellow palms of the hands and the sole of the feet within 2 months of the start of disulfiram.[Ref]

Nervous system

Nervous system side effects have included lethargy, confusion, personality changes, disorientation, and memory impairment. These effects may develop after weeks or months of disulfiram (the active ingredient contained in Antabuse) therapy. This has progressed to seizures (in the absence of a disulfiram-alcohol reaction), psychosis, catatonia and encephalopathy.

Neuropathy, generally affecting the lower extremities, occurs rarely in patients. The upper body extremities may become involved if neuropathy progresses. Optic neuritis has also been reported. Development appears to occur earlier with higher dosages. Neuropathy generally resolves over several weeks after discontinuation of disulfiram, and full recovery may require several months.[Ref]

Reports of seizures, psychosis, catatonia, and encephalopathy usually follow several weeks of higher doses of disulfiram. The incidence appears to be lower with decreased maintenance dosages. Disulfiram is an inhibitor of dopamine-beta-hydroxylase which converts dopamine to norepinephrine. Therefore disulfiram effectively lowers levels of norepinephrine and increases concentrations of dopamine which may facilitate encephalopathy and other adverse effects on the nervous system.

Neuropathy associated with disulfiram is similar in appearance to that associated with alcohol abuse. Neuropathy primarily involves axonal degeneration and affects both sensory and motor nerves. It appears to develop somewhat faster than alcohol-induced neuropathy and develops in the absence of ongoing alcohol use. A metabolite of disulfiram, carbon disulfide, has been shown to be neurotoxic and may be involved in the development of neuropathy.[Ref]

Dermatologic

Dermatologic side effects have include maculopapular rashes. Patients with a sensitivity to tetramethylthiuram disulfide, present in rubber products, may show cross-sensitivity to disulfiram (the active ingredient contained in Antabuse) [Ref]

Gastrointestinal

Gastrointestinal side effects have included an unpleasant metallic or garlic-like taste in the mouth and bad breath.[Ref]

Ocular

Ocular side effects have included optic neuritis. It appears to occur earlier with higher dosages and generally resolves over several weeks after discontinuation of disulfiram (the active ingredient contained in Antabuse) Full recovery may require several months.[Ref]

References

1. Jones RO "Death following the ingestion of alcohol in an antabuse treated patient." Can Med Assoc J 60 (1949): 609-12

2. van Ieperen L "Sudden death during disulfiram-ethanol reaction." S Afr Med J 66 (1984): 165

3. Elenbaas RM "Drug therapy reviews: management of the disulfiram-alcohol reaction." Am J Hosp Pharm 34 (1977): 827-31

4. Brewer C "Recent developments in disulfiram treatment." Alcohol Alcohol 28 (1993): 383-95

5. Wise JD "Disulfiram toxicity--a review of the literature." J Ark Med Soc 78 (1981): 87-92

6. "Product Information. Antabuse (disulfiram)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

7. Eisen HJ, Ginsberg AL "Letter: Disulfiram hepatotoxicity." Ann Intern Med 83 (1975): 673-5

8. Nassberger L "Disulfiram-induced hepatitis--report of a case and review of the literature." Postgrad Med J 60 (1984): 639-41

9. Schade RR, Gray JA, Dekker A, Varma RR, Shaffer RD, Van Thiel DH "Fulminant hepatitis associated with disulfiram. Report of a case." Arch Intern Med 143 (1983): 1271-3

10. Ranek L, Buch Andreasen P "Disulfiram hepatotoxicity." Br Med J 2 (1977): 94-6

11. Santonastaso M, Cecchetti E, Pace M, Piccolo D "Yellow palms with disulfiram." Lancet 350 (1997): 266

12. Mason NA "Disulfiram-induced hepatitis: case report and review of the literature." DICP 23 (1989): 872-5

13. Kristensen ME "Toxic hepatitis induced by disulfiram in a non-alcoholic." Acta Med Scand 209 (1981): 335-6

14. Bartle WR, Fisher MM, Kerenyi N "Disulfiram-induced hepatitis. Report of two cases and review of the literature." Dig Dis Sci 30 (1985): 834-7

15. Forns X, Caballeria J, Bruguera M, Salmeron JM, Vilella A, Mas A, Pares A, Rodes J "Disulfiram-induced hepatitis. report of four cases and review of the literature." J Hepatol 21 (1994): 853-7

16. Wright C, 4th Vafier JA, Lake CR "Disulfiram-induced fulminating hepatitis: guidelines for liver-panel monitoring." J Clin Psychiatry 49 (1988): 430-4

17. Cereda JM, Bernuau J, Degott C, Rueff B, Benhamou JP "Fatal liver failure due to disulfiram." J Clin Gastroenterol 11 (1989): 98-100

18. Berlin RG "Disulfiram hepatotoxicity: a consideration of its mechanism and clinical spectrum." Alcohol Alcohol 24 (1989): 241-6

19. Nassberger L "Hepatotoxicity due to disulfiram." J Toxicol Clin Toxicol 22 (1984): 403-8

20. Morris SJ, Kanner R, Chiprut RO, Schiff ER "Disulfiram hepatitis." Gastroenterology 75 (1978): 100-2

21. Black JL, Richardson JW "Disulfiram hepatotoxicity: case report." J Clin Psychiatry 46 (1985): 67-8

22. Enghusen Poulsen H, Loft S, Andersen JR, Andersen M "Disulfiram therapy--adverse drug reactions and interactions." Acta Psychiatr Scand Suppl 369 (1992): 59-65;

23. Reisberg B "Catatonia associated with disulfiram therapy." J Nerv Ment Dis 166 (1978): 607-9

24. Watson CP, Ashby P, Bilbao JM "Disulfiram neuropathy." Can Med Assoc J 123 (1980): 123-6

25. Moddel G, Bilbao JM, Payne D, Ashby P "Disulfiram neuropathy." Arch Neurol 35 (1978): 658-60

26. Weddington WW, Jr Marks RC, Verghese JP "Disulfiram encephalopathy as a cause of the catatonia syndrome." Am J Psychiatry 137 (1980): 1217-9

27. Frisoni GB, Di Monda V "Disulfiram neuropathy: a review (1971-1988) and report of a case." Alcohol Alcohol 24 (1989): 429-37

28. Hotson JR, Langston JW "Disulfiram-induced encephalopathy." Arch Neurol 33 (1976): 141-2

29. Price TR, Silberfarb PM "Disulfiram-induced convulsions without challenge by alcohol." J Stud Alcohol 37 (1976): 980-2

30. Fisher CM "'Catatonia' due to disulfiram toxicity." Arch Neurol 46 (1989): 798-804

31. McConchie RD, Panitz DR, Sauber SR, Shapiro S "Disulfiram-induced de novo seizures in the absence of ethanol challenge." J Stud Alcohol 44 (1983): 739-43

32. Ansbacher LE, Bosch EP, Cancilla PA "Disulfiram neuropathy: a neurofilamentous distal axonopathy." Neurology 32 (1982): 424-8

33. Mokri B, Ohnishi A, Dyck PJ "Disulfiram neuropathy." Neurology 31 (1981): 730-5

34. Liddon SC, Satran R "Disulfiram (Antabuse) psychosis." Am J Psychiatry 123 (1967): 1284-9

35. Fisher AA "Dermatologic aspects of disulfiram (Antabuse) use." Cutis 30 (1982): 461,

36. Mathelierfusade P, Leynadier F "Occupational allergic contact reaction to disulfiram." Contact Dermatitis 31 (1994): 121-2

37. Fernandez D "Another esophageal rupture after alcohol and disulfiram." N Engl J Med 286 (1972): 610

38. Christensen JK, Ronsted P, Vaag UH "Side effects after disulfiram. Comparison of disulfiram and placebo in a double-blind multicentre study." Acta Psychiatr Scand 69 (1984): 265-73

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