03/04/2009 19:50


Brand Name: Antabuse

Pregnancy Category C

Drug classes: Antialcoholic agent, Enzyme inhibitor


Therapeutic actions

Inhibits the enzyme aldehyde dehydrogenase, blocking oxidation of alcohol and allowing acetaldehyde to accumulate to concentrations in the blood 5–10 times higher than normally achieved during alcohol metabolism; accumulation of acetaldehyde produces the highly unpleasant reaction described below that deters consumption of alcohol.



· Aids in the management of selected chronic alcoholics who want to remain in a state of enforced sobriety



· Contraindicated with allergy to disulfiram or other thiuram derivatives used in pesticides and rubber vulcanization, severe myocardial disease or coronary occlusion; psychoses, current or recent treatment with metronidazole, paraldehyde, alcohol, alcohol-containing preparations (eg, cough syrups, tonics), pregnancy.


Adverse effects

Drowsiness, fatigability, headache, restlessness, peripheral neuropathy, optic or retrobulbar neuritis

Skin eruptions, acneiform eruptions, allergic dermatitis

Metallic or garliclike aftertaste, hepatotoxicity

· Increased serum levels and risk of toxicity of phenytoin and its congeners, diazepam, chlordiazepoxide

· Increased therapeutic and toxic effects of theophyllines

· Increased PT caused by disulfiram may lead to a need to adjust dosage of oral anticoagulants

· Severe alcohol-intolerance reactions with any alcohol-containing liquid medications (eg, elixirs, tinctures)

· Acute toxic psychosis with metronidazole

Nursing considerations

· Do not administer until patient has abstained from alcohol for at least 12 hr.

· Administer orally; tablets may be crushed and mixed with liquid beverages.

· Monitor liver function tests before, in 10–14 days, and every 6 mo during therapy to evaluate for hepatic dysfunction.

· Monitor CBC, SMA-12 before and every 6 mo during therapy.

· Inform patient of the seriousness of disulfiram-alcohol reaction and the potential consequences of alcohol use: disulfiram should not be taken for at least 12 hr after alcohol ingestion, and a reaction may occur up to 2 wk after disulfiram therapy is stopped; all forms of alcohol must be avoided.

· Arrange for treatment with antihistamines if skin reaction occurs.