Antabuse (Disulfiram). Dosage, Side Effects, Interactions
Antabuse is used to treat the symptoms of alcoholism. Antabuse can be used alone or with other medications.
Antabuse belongs to a class of drugs called Psychiatry Agents, Other.
It is not known if Antabuse is safe and effective in children.
INDICATIONS FOR ANTABUSE
Disulfiram is an adjunct in the management of select chronic alcohol patients who wish to remain in a state of enforced sobriety so that supportive and psychotherapeutic care can be optimally administered.
Disulfiram is not a cure for alcoholism. Used alone without proper motivation and supportive therapy, it is unlikely to have a significant impact on the chronic alcoholic’s drinking behavior.
DOSAGE AND APPLICATION OF ANTABUSE
Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours.
Initial dosing schedule
In the first treatment phase, a maximum of 500 mg is administered daily in a single dose for one to two weeks. Although disulfiram is usually taken in the morning, it can be taken in retired patients for a sedative effect. Alternatively, the dosage can be adjusted downwards to minimize or eliminate the sedative effects.
The average maintenance dose is 250 mg daily (range 125 to 500 mg) and should not exceed 500 mg daily.
Note: Occasionally, despite appearing to be receiving an adequate maintenance dose of disulfiram, patients report being able to drink alcoholic beverages with impunity and without symptoms. For all occurrences to the contrary, it must be assumed that such patients will in some way dispose of their tablets without actually taking them. Until such patients have been observed to reliably take their daily disulfiram tablets (preferably crushed and mixed well with liquid), it cannot be concluded that disulfiram is ineffective.
Duration of therapy
Daily, uninterrupted administration of disulfiram must be continued until the patient has fully recovered socially and a basis for sustained self-control is established. Depending on the patient, maintenance therapy may be required for months or even years.
During early experience with disulfiram, it was thought advisable that every patient have at least one monitored alcohol-drug reaction. More recently, the test response has been largely abandoned. In addition, such a test reaction should never be given to a patient over 50 years of age. A clear, detailed and convincing description of the reaction is considered sufficient in most cases.
However, if a test response is deemed necessary, the following procedure is suggested:
After the initial one to two week regimen of 500 mg daily, a drink of 15 ml (½ oz) of 100% whiskey or equivalent is slowly ingested. This test dose of an alcoholic beverage may only be repeated once so that the total dose does not exceed 30 ml of whiskey. Once a reaction develops, alcohol should be stopped. Such testing should only be performed if the patient is hospitalized or comparable monitoring and facilities, including oxygen, are available.
Management of the disulfiram-alcohol reaction
For severe reactions caused by an excessive test dose or by the patient’s uncontrolled ingestion of alcohol, supportive measures to restore blood pressure and treat shock should be instituted. Other recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), intravenous vitamin C in massive doses (1 g), and ephedrine sulfate. Antihistamines have also been used intravenously. Potassium levels should be monitored, particularly in patients with digitalis, as hypokalemia has been reported.
Side effects of Antabuse
Antabuse can cause serious side effects, including:
- eye pain or sudden loss of vision,
- unusual thoughts or behavior
- epigastric pain,
- loss of appetite,
- dark urine,
- clay colored stool,
- yellowing of the skin or eyes (jaundice),
- flushing (warmth, redness or tingly feeling),
- increased thirst,
- rapid weight gain,
- severe vomiting,
- neck pain,
- throbbing headache,
- blurred vision,
- chest pain,
- Shortness of breath,
- fast or pounding heartbeats,
- flutter in your chest
- spinning feeling,
- feel insecure and
The most common side effects of Antabuse are:
- Skin rash,
- a mild headache,
- tired feeling
- Loss of interest in sex and
- metallic or garlic-like taste in the mouth
Tell the doctor if you have any side effects that bother you or that don’t go away.
These are not all possible side effects of Antabuse. For more information, contact your doctor or pharmacist.
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