Mental Health Book

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AntabuseAka: Disulfiram

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  1. Background
    1. Used since 1951
  2. Mechanism
    1. Buildup of acetaldehyde if drinks on Antabuse
    2. Taking Antabuse seals daily sobriety contract
      1. Today they will not drink
  3. Efficacy
    1. No better than Placebo
  4. Contraindications
    1. Concurrent use of medications with drug interaction
      1. Metronidazole (Flagyl)
      2. Medication containing Alcohol (e.g. some inhalers)
    2. Age over 60 years
    3. Comorbid illness
      1. Cirrhosis with Portal Hypertension
      2. Coronary Artery Disease
      3. Chronic Renal Failure
      4. Diabetes Mellitus
      5. Peripheral Neuropathy
      6. Seizure disorder
      7. Severe respiratory disease
    4. Prior Psychosis on Antabuse
  5. Medication Interactions
    1. See contraindications above for other interactions
    2. Medications that raise antabuse levels
      1. SSRI
      2. Tricyclic Antidepressants
      3. Dilantin
      4. Coumadin
      5. Isoniazid
      6. Unsteady gait
  6. Symptoms and Signs of Antabuse with Alcohol reaction
    1. Headache
    2. Nausea and Vomiting
    3. Large red hot pruritic rash
    4. Shortness of Breath
    5. Cardiac arrest
    6. Seizure
    7. Coma
    8. Death
  7. Adverse Effects of Antabuse alone
    1. Fatigue (resolves after 2-3 weeks)
    2. Garlic breath
    3. Metallic Taste
    4. Acne (Treat with non-Alcohol based Comedolytic)
    5. Rare neurologic sequelae
    6. Rare hepatotoxicity
  8. Management of Alcohol-Antabuse reaction
    1. Benadryl 50 mg IM
      1. Give additional Benadryl for home
  9. Lab Monitoring (consider, done by some clinicians)
    1. Liver Function Tests
      1. Baseline, 2 weeks, 3 months and then every 6 months
  10. Pregnancy
    1. Category C
  11. Dose
    1. Antabuse 250 mg PO qd
  12. Precautions
    1. Counsel: life threatening risk Alcohol and Antabuse
    2. If choosing to drink, wait 14 days after last Antabuse
    3. Alcohol-Antabuse reactions occur at low Alcohol levels
    4. Do not use Flagyl with Antabuse
    5. Read Labels: Alcohol is in many products!
      1. Flavoring in frosting
      2. Sauces
      3. Wine Vinegar (14% Alcohol)
      4. Aerosol propellant (Hair spray)
      5. Skin absorption
        1. Alcohol swab on lab draw
        2. Hand lotion
        3. Soap
      6. Gel toothpaste
      7. Mouthwash
      8. Cough lozenge, Cough medications
      9. Nyquil (35% Alcohol)
    6. Every patient must have a medic alert card
      1. Alerts that patient is in on Antabuse
      2. Do not give Alcohol, paraldehyde or related product
    7. Every patient should sign a witnessed consent
    8. Patient Education handouts are highly recommended
    9. Document that the above has been reviewed with patient

Disulfiram (C0012772)

Definition (MSH)A carbamate derivative used as an alcohol deterrent. It is a relatively nontoxic substance when administered alone, but markedly alters the intermediary metabolism of alcohol. When alcohol is ingested after administration of disulfiram, blood acetaldehyde concentrations are increased, followed by flushing, systemic vasodilation, respiratory difficulties, nausea, hypotension, and other symptoms (acetaldehyde syndrome). It acts by inhibiting aldehyde dehydrogenase.
Definition (CSP)carbamate derivative used as an alcohol deterrent; it is a relatively nontoxic substance when administered alone, but markedly alters the intermediary metabolism of alcohol; when alcohol is ingested after administration of disulfiram, blood acetaldehyde concentrations are increased, followed by flushing, systemic vasodilation, respiratory difficulties, nausea, hypotension, and other symptoms (acetaldehyde syndrome); it acts by inhibiting aldehyde dehydrogenase.
Definition (NCI)A drug that slows the metabolism of retinoids, allowing them to act over a longer period of time.
Definition (PDQ)A carbamoyl derivate used in the treatment of alcoholism. Disulfiram irreversibly inhibits acetaldehyde dehydrogenase that oxidizes the ethanol metabolite acetaldehyde into acetic acid. This leads to an accumulation of acetaldehyde that produces a variety of very unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction includes , but is not limited to, flushing, headache, respiratory difficulty, nausea,vomiting, sweating, thirst, chest pain, tachycardia, blurred vision and hypotension. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42291&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42291&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C447" NCI Thesaurus)
Definition (NCI)A carbamoyl derivate used in the treatment of alcoholism. Disulfiram irreversibly inhibits acetaldehyde dehydrogenase that oxidizes the ethanol metabolite acetaldehyde into acetic acid. This leads to an accumulation of acetaldehyde that produces a variety of very unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction includes , but is not limited to, flushing, headache, respiratory difficulty, nausea,vomiting, sweating, thirst, chest pain, tachycardia, blurred vision and hypotension.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishDisulfiram, DISULFIRAM PREPARATION, Disulfiram product, Disulphiram, Disulphiram product, DS, Tetraethylthioperoxydicarbonic Diamide, Tetraethylthiuram Disulfide, Tetraethylthiuram disulphide, Teturamin, TTD
Spanishdisulfiram, disulfuro de tetraetiltiuram, tetraetiltiuram disulfuro
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Antabuse (C0591096)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishAllphar Brand of Disulfiram, Antabuse, Odyssey Brand of Disulfiram, Orphan Brand of Disulfiram
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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