Drug Interaction Report

ADJUST DOSE: The combination of disulfiram and benzodiazepines may increase CNS depression. The mechanism may relate to the inhibition of hepatic oxidation of benzodiazepines by disulfiram. Diazepam and chlordiazepoxide may interact with disulfiram to a greater extent than other benzodiazepines. However, the interaction has also been reported with temazepam, even though it is metabolized by glucuronidation.

MANAGEMENT: The benzodiazepine dosage may require reduction. Patients should be monitored for excessive and prolonged sedation.

CONTRAINDICATED: Consumption of ethanol during treatment with disulfiram may cause flushing, nausea, blurred vision, dyspnea, tachypnea, tachycardia, and hypotension. Death has been reported. The mechanism is probably related to inhibition of aldehyde dehydrogenase, the enzyme responsible for the oxidation of acetaldehyde to acetyl CoA. Accumulation of acetaldehyde probably results.

MANAGEMENT: Ethanol should be avoided in patients receiving disulfiram.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.