DISULFIRAM

brands

Class

• Alcohol dependence treatment

DISULFIRAM commonly prescribed for

(Bold for FDA approved)

How DISULFIRAM works

• Irreversibly inhibits aldehyde dehydrogenase, the enzyme involved in second-stage metabolism of alcohol</br>

• Alcohol is metabolized to acetaldehyde, which in turn is metabolized by aldehyde dehydrogenase; thus, disulfiram blocks this second-stage metabolism</br>

• If alcohol is consumed by a patient taking disulfiram, toxic levels of acetaldehyde build up, causing unpleasant side effects</br>

• This aversive experience ideally leads to negative conditioning, in which patients abstain from alcohol in order to avoid the unpleasant effects

How long until DISULFIRAM works

• Disulfiram’s effects are immediate; patients should not take disulfiram until at least 12 hours after drinking

Notable Side Effects

• Metallic taste, dermatitis, sedation

• Flushing, headache, tachycardia, nausea, vomiting (if alcohol is consumed)

Life Threatening Side Effects

• Hepatotoxicity

• Myocardial infarction, congestive heart failure, respiratory depression, other signs of alcohol toxicity (if alcohol is consumed)

weight gain

unusual

sedation

not usual

What to do about DISULFIRAM side effects

• Wait

• Reduce dose

• Take at night to reduce sedation

usual dosage range

• 250–500 mg/day; 1-year duration

Dosage Forms

• Tablet 250 mg, 500 mg scored

long term use

• Maintenance treatment should be continued until the patient is recovered

habit forming

• No

Renal Impairment

• Not recommended for patients with chronic renal failure

Hepatic Impairment

• Not recommended

Cardiac Impairment

• Contraindicated

Elderly

• Not generally recommended for patients older than age 60

• Some patients may tolerate lower doses better

Children and Adolescents

• Safety and efficacy have not been established

Pregnancy

• Effective June 30, 2015, the FDA requires changes to the content and format of pregnancy and lactation information in prescription drug labels, including the elimination of the pregnancy letter categories; the Pregnancy and Lactation Labeling Rule (PLLR or final rule) applies only to prescription drugs and will be phased in gradually for drugs approved on or after June 30, 2001

• Controlled studies have not been conducted in pregnant women

• Some animal studies have shown adverse effects

• Pregnant women needing to stop drinking may consider behavioral therapy before pharmacotherapy

• Not generally recommended for use during pregnancy, especially during first trimester

Breast Feeding

• Unknown if disulfiram is secreted in human breast milk, but all psychotropics are assumed to be secreted in breast milk

• Recommended either to discontinue drug or bottle feed