Drugs List

Therapeutic Indications

Uses

Alcoholism (adjunctive treatment)

Contraindications

Children under 18 years
Suicidal ideation
Acute porphyria
Breastfeeding
Cardiac failure
History of cerebrovascular accident
Hypertension
Ischaemic heart disease
Personality disorder
Pregnancy
Psychosis

Precautions and Warnings

Brain damage
Diabetes mellitus
Epileptic disorder
Hepatic impairment
Hypothyroidism
Renal impairment
Respiratory disease

Advise ability to drive or operate machinery may initially be impaired
Provide supportive therapy in conjunction with treatment
Treatment to be initiated and supervised by a specialist
Treatment to be initiated by specialist
Establish suitability of patient via tests prior to start of treatment
Evaluate need for continued treatment after 6 months
Advise patient of severity and danger from reaction with alcohol
Reactions to alcohol can occur within 10 mins & can last for several hours
Advise patient about 'alcohol free' beers and wines
Advise patient that certain foods, medicines and toiletries contain alcohol
Advise patient to avoid alcohol during treatment & for2 week after stopping
Alcohol should not be ingested for at least 24 hours prior to treatment

All persons involved in administering disulfiram to the patient should be aware of the potentially dangerous consequences of taking alcohol concurrently.

An alcohol challenge test is not recommended in the routine management of patients with alcohol dependence taking disulfiram - an explicit description of the disulfiram-alcohol reaction is usually sufficient. However if testing is considered essential for the success of therapy, it should be carried out in specialist units with resuscitation facilities. Contact the manufacturer for full information on the procedures and risks involved.

Alcohol should not be ingested for at least 24 hours before commencing and one week after ceasing disulfiram therapy because of the potentially dangerous disulfiram-alcohol reaction. While on treatment patients should be warned to avoid alcohol in any form e.g. foods, liquid medicines, remedies, tonics, toiletries including mouthwashes, perfumes, and aerosols, as these may contain sufficient alcohol to elicit a reaction. Caution should also be exercised with low alcohol, 'non-alcohol', or 'alcohol free' beers and wines as these may elicit a reaction if taken in sufficient quantities.

Pregnancy and Lactation

Pregnancy

Disulfiram is contraindicated in pregnancy.

Briggs suggests the available data in humans and animals do not indicate that disulfiram is a major human teratogen. Some sources suggest high concentrations of acetaldehyde, which occur in the presence of alcohol, may be teratogenic. The manufacturer suggests the use of disulfiram during the first trimester of pregnancy should only be administered if the potential benefit to the mother outweigh any potential risk to the foetus.

Congenital abnormalities have been reported in infants whose mothers received disulfiram in conjunction with other medicines.

The molecular weight of disulfiram (about 297) is low enough that transfer to the foetus may occur.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Disulfiram is contraindicated in breastfeeding.

The manufacturer suggests should not be used in breastfeeding.

At the time of writing no information is available on excretion of disulfiram in breast milk. The low molecular weight of disulfiram, excretion in breast milk should be expected. Disulfiram could interact with medicines that the breastfeeding infant might be taking.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acne
After taste
Allergic dermatitis
Altered liver function tests
Behavioural disturbances
Blood dyscrasias
Confusion
Convulsions
Depression
Diarrhoea
Disulfiram-alcohol reactions on ingestion of alcohol
Drowsiness
Elevation of liver enzymes
Encephalopathy
Fatigue
Halitosis
Headache
Hepatitis
Hepatotoxicity
Hypersensitivity reactions
Jaundice
Liver damage
Mania
Nausea
Optic neuritis
Paranoia
Peripheral neuritis
Polyneuropathy
Pruritus
Psychotic reactions
Rash
Reduced libido
Schizophrenia
Sexual dysfunction
Somnolence
Tremor
Upper abdominal pain
Vomiting

Presentation

Oral formulation of disulfiram.

Drugs List

Therapeutic Indications

Uses

Alcoholism (adjunctive treatment)

Dosage

Adults

Additional Dosage Information

Contraindications

Children under 18 years
Suicidal ideation
Acute porphyria
Breastfeeding
Cardiac failure
History of cerebrovascular accident
Hypertension
Ischaemic heart disease
Personality disorder
Pregnancy
Psychosis

Precautions and Warnings

Brain damage
Diabetes mellitus
Epileptic disorder
Hepatic impairment
Hypothyroidism
Renal impairment
Respiratory disease

Advise ability to drive or operate machinery may initially be impaired
Provide supportive therapy in conjunction with treatment
Treatment to be initiated and supervised by a specialist
Treatment to be initiated by specialist
Establish suitability of patient via tests prior to start of treatment
Evaluate need for continued treatment after 6 months
Advise patient of severity and danger from reaction with alcohol
Reactions to alcohol can occur within 10 mins & can last for several hours
Advise patient about 'alcohol free' beers and wines
Advise patient that certain foods, medicines and toiletries contain alcohol
Advise patient to avoid alcohol during treatment & for2 week after stopping
Alcohol should not be ingested for at least 24 hours prior to treatment

All persons involved in administering disulfiram to the patient should be aware of the potentially dangerous consequences of taking alcohol concurrently.

An alcohol challenge test is not recommended in the routine management of patients with alcohol dependence taking disulfiram - an explicit description of the disulfiram-alcohol reaction is usually sufficient. However if testing is considered essential for the success of therapy, it should be carried out in specialist units with resuscitation facilities. Contact the manufacturer for full information on the procedures and risks involved.

Alcohol should not be ingested for at least 24 hours before commencing and one week after ceasing disulfiram therapy because of the potentially dangerous disulfiram-alcohol reaction. While on treatment patients should be warned to avoid alcohol in any form e.g. foods, liquid medicines, remedies, tonics, toiletries including mouthwashes, perfumes, and aerosols, as these may contain sufficient alcohol to elicit a reaction. Caution should also be exercised with low alcohol, 'non-alcohol', or 'alcohol free' beers and wines as these may elicit a reaction if taken in sufficient quantities.

Pregnancy and Lactation

Pregnancy

Disulfiram is contraindicated in pregnancy.

Briggs suggests the available data in humans and animals do not indicate that disulfiram is a major human teratogen. Some sources suggest high concentrations of acetaldehyde, which occur in the presence of alcohol, may be teratogenic. The manufacturer suggests the use of disulfiram during the first trimester of pregnancy should only be administered if the potential benefit to the mother outweigh any potential risk to the foetus.

Congenital abnormalities have been reported in infants whose mothers received disulfiram in conjunction with other medicines.

The molecular weight of disulfiram (about 297) is low enough that transfer to the foetus may occur.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Disulfiram is contraindicated in breastfeeding.

The manufacturer suggests should not be used in breastfeeding.

At the time of writing no information is available on excretion of disulfiram in breast milk. The low molecular weight of disulfiram, excretion in breast milk should be expected. Disulfiram could interact with medicines that the breastfeeding infant might be taking.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acne
After taste
Allergic dermatitis
Altered liver function tests
Behavioural disturbances
Blood dyscrasias
Confusion
Convulsions
Depression
Diarrhoea
Disulfiram-alcohol reactions on ingestion of alcohol
Drowsiness
Elevation of liver enzymes
Encephalopathy
Fatigue
Halitosis
Headache
Hepatitis
Hepatotoxicity
Hypersensitivity reactions
Jaundice
Liver damage
Mania
Nausea
Optic neuritis
Paranoia
Peripheral neuritis
Polyneuropathy
Pruritus
Psychotic reactions
Rash
Reduced libido
Schizophrenia
Sexual dysfunction
Somnolence
Tremor
Upper abdominal pain
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: September 2016

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Disulfiram tablets 200 mg. Actavis UK Ltd. Revised December 2011.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 18 August 2017