(dye SUL fi ram)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Antabuse: 250 mg
Antabuse: 500 mg [scored]
Generic: 250 mg, 500 mg
Brand Names: U.S.
- Aldehyde Dehydrogenase Inhibitor
Disulfiram is a thiuram derivative which interferes with aldehyde dehydrogenase. When taken concomitantly with alcohol, there is an increase in serum acetaldehyde levels. High acetaldehyde causes uncomfortable symptoms including flushing, nausea, thirst, palpitations, chest pain, vertigo, and hypotension. This reaction is the basis for disulfiram use in postwithdrawal long-term care of alcoholism.
Feces and exhaled gases (as metabolites)
Onset of Action
Full effect: 12 hours
Duration of Action
~1-2 weeks after last dose
Use: Labeled Indications
Management of chronic alcoholism
Hypersensitivity to disulfiram and related compounds or any component of the formulation or to other thiuram derivatives used in pesticides and rubber vulcanization; patients receiving or using ethanol, metronidazole, paraldehyde, or ethanol-containing preparations like cough syrup or tonics; psychosis; severe myocardial disease and coronary occlusion
Alcoholism: Oral: Note: Do not administer until the patient has abstained from ethanol for at least 12 hours.
Initial: 500 mg once daily for 1-2 weeks (maximum daily dose: 500 mg)
Average maintenance dose: 250 mg once daily (range: 125-500 mg; maximum daily dose: 500 mg); duration of therapy is to continue until the patient is fully recovered socially and a basis for permanent self-control has been established; maintenance therapy may be required for months or even years.
Refer to adult dosing.
Dosing: Renal Impairment
No dosage adjustment provided in manufacturer’s labeling. Use with extreme caution in chronic and acute nephritis.
Dosing: Hepatic Impairment
No dosage adjustment provided in manufacturer’s labeling. Use with extreme caution in hepatic cirrhosis or insufficiency.
Administration of any medications containing alcohol, including topicals, is contraindicated. Do not administer disulfiram if ethanol has been consumed within the prior 12 hours. Morning administration is preferred, but may be given at bedtime if sedation is experienced.
Do not administer disulfiram if ethanol has been consumed within the prior 12 hours.
Alcohol (Ethyl): Disulfiram may enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Avoid combination
ARIPiprazole: CYP2D6 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult full interaction monograph for specific recommendations. Monitor therapy
Atazanavir: May diminish the therapeutic effect of Disulfiram. Monitor therapy
Carbocisteine: Disulfiram may enhance the adverse/toxic effect of Carbocisteine. Specifically, disulfiram may enhance adverse effects of alcohol that is present in liquid formulations of carbocisteine-containing products. Avoid combination
ChlordiazePOXIDE: Disulfiram may increase the serum concentration of ChlordiazePOXIDE. Monitor therapy
Chlorzoxazone: Disulfiram may decrease the metabolism of Chlorzoxazone. Monitor therapy
CYP2E1 Substrates: CYP2E1 Inhibitors (Strong) may decrease the metabolism of CYP2E1 Substrates. Consider therapy modification
DiazePAM: Disulfiram may increase the serum concentration of DiazePAM. Monitor therapy
Flunitrazepam: Disulfiram may increase the serum concentration of Flunitrazepam. Monitor therapy
Fosphenytoin: Disulfiram may increase the serum concentration of Fosphenytoin. Management: Avoid concomitant use of disulfiram and phenytoin when possible. Phenytoin dose adjustment will likely be necessary when starting and/or stopping concurrent disulfiram. Monitor phenytoin response and concentrations closely. Consider therapy modification
Isoniazid: Disulfiram may enhance the adverse/toxic effect of Isoniazid. Disulfiram may increase the serum concentration of Isoniazid. Monitor therapy
Lopinavir: May enhance the adverse/toxic effect of Disulfiram. Specifically, the combination of lopinavir/ritonavir solution, which contains 42% alcohol, may result in a disulfiram-alcohol reaction if combined. Avoid combination
MetroNIDAZOLE (Systemic): Disulfiram may enhance the adverse/toxic effect of MetroNIDAZOLE (Systemic). Avoid combination
MetroNIDAZOLE (Topical): May enhance the adverse/toxic effect of Disulfiram. Management: Warn patients and monitor for the development of serious CNS toxicity if topical metronidazole is used in a patient taking disulfiram. Some manufacturers of vaginal metronidazole products list disulfiram use within 2 weeks as a contraindication. Consider therapy modification
Paraldehyde: Disulfiram may increase the serum concentration of Paraldehyde. Avoid combination
Perhexiline: CYP2D6 Inhibitors (Weak) may increase the serum concentration of Perhexiline. Monitor therapy
Phenytoin: Disulfiram may increase the serum concentration of Phenytoin. Management: Avoid concomitant use of disulfiram and phenytoin when possible. Phenytoin dose adjustment will likely be necessary when starting and/or stopping concurrent disulfiram. Monitor phenytoin response and concentrations closely. Consider therapy modification
Ritonavir: May enhance the adverse/toxic effect of Disulfiram. Specifically, the combination of ritonavir oral solution, which contains 43% alcohol, may result in a disulfiram-alcohol reaction if combined. Avoid combination
Sertraline: Disulfiram may enhance the adverse/toxic effect of Sertraline. This is specifically related to sertraline oral concentrate due to its alcohol content (12%). Management: Sertraline Oral Concentrate contains 12% alcohol, and its use should be avoided with disulfiram. Avoid combination
Theophylline Derivatives: Disulfiram may increase the serum concentration of Theophylline Derivatives. Exceptions: Dyphylline. Monitor therapy
Tinidazole: May enhance the adverse/toxic effect of Disulfiram. Avoid combination
Tipranavir: Disulfiram may enhance the adverse/toxic effect of Tipranavir. Consider therapy modification
TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Disulfiram may increase the serum concentration of Vitamin K Antagonists. Monitor therapy
Frequency not defined.
Central nervous system: Aftertaste (metallic or garlic-like), drowsiness, fatigue, headache, peripheral neuritis, peripheral neuropathy, polyneuropathy, psychosis
Dermatologic: Acneiform eruption, allergic dermatitis, skin rash
Hepatic: Cholestatic hepatitis, fulminant hepatitis, hepatic failure (multiple case reports)
Ophthalmic: Optic neuritis
Concerns related to adverse effects:
• Hepatotoxicity: Severe (sometimes fatal) hepatitis and/or hepatic failure have been associated with use; may occur in patients with or without prior history of abnormal hepatic function.
• Diabetes: Use with caution in patients with diabetes mellitus.
• Hepatic impairment: Use with caution in patients with hepatic cirrhosis or impairment.
• Hypothyroidism: Use with caution in patients with hypothyroidism.
• Nephritis: Use with caution in patients with acute or chronic nephritis.
• Seizures: Use with caution in patients with a history of seizure disorder.
• Ethanol intoxication: [U.S. Boxed Warning]: Should never be administered to a patient when he/she is in a state of ethanol intoxication, or without his/her knowledge.
• Patient information: Patients must receive appropriate counseling, including information on “disguised” forms of ethanol (tonics, mouthwashes, etc) and the duration of the drug's activity (up to 14 days).
Liver function tests at baseline and after 10-14 days of treatment; a complete CBC and serum chemistries should also be monitored
Safety in pregnancy has not been established; there is limited data on maternal use during pregnancy (Reitnauer,1997).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience fatigue, loss of strength and energy, sexual dysfunction, acne, headache, or change in taste. Have patient report immediately to prescriber vision changes, burning or numbness feeling, mood changes, behavioral changes, or signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
More about disulfiram
- Other brands: Antabuse