Odyssey Pharmaceuticals; available as generic disulfiram.
Helpful in the treatment of a select subpopulation of alcoholics who are highly motivated to stay sober and who are receiving supportive therapy, either from a professional or in the context of Alcoholics Anonymous.
Blocks the metabolism of acetaldehyde, causing it to build up to 5 to 10 times the level normally present after a drink of alcohol, causing a highly unpleasant reaction when any alcohol is ingested.
Supplied as 250 mg tablets (breakable).
Manufacturer recommends starting at 500 mg QD but this is rarely done, because of side effects.
More reasonable dosing is to start at 125 mg QPM, and to increase to 250 mg QPM after several days.
Maintenance dose is usually 250 mg QPM, but some patients can drink without a reaction on this dose; if so, increase to 375 mg or 500 mg QPM.
Common: Initial fatigue, nausea, diarrhea, metallic taste in mouth.
Uncommon but potentially dangerous:
Can cause elevated liver function tests and even hepatitis.
Can cause peripheral neuropathy and optic neuritis.
Contraindicated in combination with alcohol. The alcohol-disulfiram reaction can cause flushing, headache, nausea, vomiting, tachycardia, and in very rare instances, cardiovascular collapse and death. Common advice to patients: “You’ll wish you were dead but it won’t kill you.”
Antabuse has a long half-life, so an alcohol reaction can occur as long as a week after the last dose. On the other hand, alcohol is rapidly metabolized, so patients can take their first dose 12 hours after their last drink.
Warn patients not to combine Antabuse with: Flagyl (an antibiotic), paraldehyde (a sedative rarely used these days), over-the-counter medications that contain small amounts of alcohol, like many cough syrups and Nyquil.
Do not give to patients with severe cardiac disease or to patients who are acutely psychotic.
Can increase levels of Dilantin, Coumadin, and isoniazid.