Disulfiram

Disulfiram is a widely used antioxidant in rubber industry, causes extreme discomfort to patients who drink alcoholic beverages.Disulfiram is useful as a pharmacologic adjunct in the treatment of alcoholism. Disulfiram is given to persons who are seriously desiring to stop alcohol intake. It causes an intolerance to alcohol. It produces unpleasant reactions of flushing, headache, nausea, vomiting, dizziness, sweating, pounding heart, blurred vision when person ingested even small amounts of alcohol.

Brands
ZANTI-ABUSE
Adult Dose
Dose: 1.786 to 7.143 mg/kg
Single Dose: 4.5 (4.4645)
Frequency: 24 hourly
Route: PO
Instructions: Maintenance, As Required
Neonatal
Paedriatic
Characteristics
. It is of Synthetic origin and belongs to Alkyl Thiuram. It belongs to Alcohol dehydrogenase inhibitor pharmacological group on the basis of mechanism of action and also classified in Antidotes pharmacological group.The Molecular Weight of Disulfiram is 296.50. Its pKa is not relevant.
Contraindications
Disulfiram is contraindicated in conditions like Psychosis,Peripheral neuropathy,Cardiovascular disease.
Effects
The severe or irreversible adverse effects of Disulfiram, which give rise to further complications include Encephalopathy, Convulsions, Hepatotoxicity, Peripheral neuropathy, Optic neuritis, Psychosis, Neuropsychiatric damage, Cardiovascular toxicity, Hepatotoxicity, Acetonemia, Optic atrophy.Disulfiram produces potentially life-threatening effects which include Myocardial infarction, Cerebrovascular hemorrhage, Cerebrovascular infarction, Cerebrovascular hemorrhage. which are responsible for the discontinuation of Disulfiram therapy.The signs and symptoms that are produced after the acute overdosage of Disulfiram include Encephalopathy, Confusion, Pyrexia, Aggression, Mild ketosis, Subacute flaccid tetraparesis, Somnolence, Decreased muscle tone.The symptomatic adverse reactions produced by Disulfiram are more or less tolerable and if they become severe, they can be treated symptomatically, these include Headache, Drowsiness, Fatigue, Nausea, Vomiting, Insomnia, VertigoX, Halitosis, Decrease in libido, Psychomimetic reaction, Allergic dermatitis.
Indications
Disulfiram is primarily indicated in conditions like Alcohol abuse, Nickel dermatitis.
Interactions
Disulfiram is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholDisulfiram inhibit enzyme aldehyde dehydrogenase responsible for oxidation of acetaldehyde to acetylCoA thusduring cosumption of alcohol flushing,nausea,blurred vision,hypotension and tachycardia may occur.MajorAlcohol should be avoided in patients receiving disulfiram.AlprazolamAminophyllineAmisulprideAmitriptyline (HCl)CaffeineDue to inhibition of caffeine metabolism in liver microsomes its concentration may be increases in cardiovascular and CNS .MinorCaffeine intake should be limited while taking disulfiram.CarbamazepineChlorpromazine (HCl)ChlorzoxazoneEsomeprazoleCoadministration results in toxicityFosphenytoinIproniazid PhosphateInfrequent reports of IPRONIAZID increasing the CNS TOXICITY of DISULFIRAM. MajorMay need to avoid combination.IsoniazidCoadministration causes blockade of dopamine metabolism and results in excess dopaminergic activity.ModerateClosely monitored the altered mental status.Dose of disulfiram must be adjusted.Methotrimeprazine (Maleate)MetronidazoleCoadministration results in confusion and acute psychoses.ModerateMetronidazole should not be administered when using disulfiram.MetronidazoleMorphineNafcillinDisulfiram may increase Nafcillin sodium levels.Oxtriphylline (Choline Theophyllinate)ParaldehydeConcurrent use is not recommended, but may be required in some cases.If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.Pethidine (HCl)PhenazonePhenytoin (Na)Disulfiram may inhibit hepatic microsomal metabolism of phenytoin and decreases its elimination rate thus increasing serum level upto 73% to 500%.Moderateclosely observed yhe serum level and toxicity of phenytoin.PodophyllumThe risk of peripheral neuropathy may be increased during concurrent use of two or more agents that are associated with this adverse effect. In some cases, the neuropathy may progress or become irreversible despite discontinuation of the medications.ModerateCaution is advised during concomitant use of agents with neurotoxic effects. Patients should be monitored closely for symptoms of neuropathy such as burning, tingling, pain, or numbness in the hands and feet. Since the development of peripheral neuropathy may be dose-related for many drugs, the recommended dosages should generally not be exceeded.PrazepamPromazine (HCl)RifampicinRitonavirSulbactamSulfapyridineConcurrent use with sulfonamides may result in an increased incidence of hepatotoxicity. Patients, especially those on prolonged administration or those with a history of liver disease.Should be carefully monitored.SulpirideWarfarin (Na)Disulfiram may increase the serum concentration of Warfarin. ModerateDelayedMonitor for increased therapeutic effects of Warfarin if Disulfiram is initiated/dose increased, or decreased effects if Disulfiram is discontinued/dose decreased. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Liver Function Test (LFT)
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Tab Store Below 40°C. Protect from Sunlight and Moisture.
Warnings
It should be used with caution in patients with diabetes mellitus, epilepsy, impaired liver or kidney function, respiratory disorder, cerebral damage or hypothyroidism. Disulfiram should not be given until atleast 24 hours after the last ingestion of alcohol. Do not use food, medication, liniments or lotions including after-shaves that contain alcohol. It is classified as pregnancy category B. Consult the doctor about the use of this medication in pregnant or nursing women. It should never be administered to patient with ethanol intoxication.
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