Editor. WARNING: Institute supportive measures if disulfiram-alcohol reaction occurs; oxygen, carbon dioxide combination, massive doses of vitamin C IV, ephedrine have been used. Lidocaine is a CYP3A4 and CYP1A2 substrate; disulfiram inhibits CYP1A2. Hypersensitivity to the drug is the only known contraindication. The AUC of a sensitive CYP3A substrate was increased 5.4-fold when coadministered with idelalisib. you have severe heart disease or blockage in the arteries of your heart; or. Therefore, patients with rubber contact dermatitis should be evaluated for hypersensitivity to disulfiram. TY - ELEC T1 - disulfiram ID - 109180 A1 - Sanoski,Cynthia A, AU - Vallerand,April Hazard, AU - Quiring,Courtney, BT - Davis's . Design Systematic review and network meta-analysis. 1 Felician College, Lodi, NJ, USA and Drexel University, Philadelphia, PA, USA Do not administer until patient has abstained from alcohol for at least 12 hr. Patients with renal insufficiency or advanced cirrhosis should not take acamprosate, but it may be taken safely by patients with liver dysfunction.11 Like naltrexone and disulfiram, acamprosate is FDA pregnancy category C (adverse effects on the fetus in animal studies but no human trials). Max: 500 mg/day PO. Clinical monitoring for adverse effects is recommended during coadministration. In rare instances, a disulfiram-like effect, characterized by tachycardia, palpitations, facial flushing, and dysphoria, has occurred with concomitant use of ethanol and chloral hydrate. Begin with 25 mg morning dose and increase to a total of 300 mg given twice a day in divided doses. Phenytoin: (Major) Disulfiram can interfere with the metabolism of hydantoin anticonvulsants, particularly phenytoin, resulting in increased serum concentrations and possible phenytoin toxicity (i.e., ataxia, hyperreflexia, nystagmus, tremor). Be aware that many common products contain small amounts of alcohol, enough to cause a Antabuse reaction. The dose may be taken in the evening if drowsiness occurs. It undergoes slow hepatic metabolism to diethyldithiocarbamate (a dopamine hydroxylase inhibitor), diethylamine, and carbon disulfide. In a surveillance study, one major birth defect (cardiovascular) was observed (one expected) among 25 newborns who had been exposed to disulfiram during the first trimester. You may report side effects to FDA at 1-800-FDA-1088. BLACK BOX WARNING: Never administer to an intoxicated patient or without patients knowledge. Pharmacotherapy should be used as a part of a comprehensive management program that includes psychosocial support and treatment. Monitor for lidocaine toxicity if used together. Avoid coming into contact with non-consumable products that may contain alcohol: paint thinners, solvents, stains, lacquers and others. DP - Unbound Medicine The mechanism is most likely due to inhibition of CYP2C9 by disulfiram. In. five to fifteen minutes with a general practitioner or 20 to 30 minutes with a practice nurse, can reduce the amount of alcohol people drink by an average of two standard drinks per week. Monitor for lidocaine toxicity if used together. Make sure patient has abstained from alcohol and alcohol-containing preparations for at least 12 h and preferably 48 h before Ethanol is initially metabolized to acetaldehyde by alcohol dehydrogenase. According to the manufacturer, it is not known if disulfiram is excreted into human milk, and disulfiram should not be given to mothers who are breast-feeding. Aspirin, ASA; Caffeine: (Moderate) Disulfiram has been shown to inhibit caffeine elimination. Terbinafine is metabolized by at least 7 CYP isoenyzmes, with major contributions coming from CYP1A2; disulfiram is an inhibitor of this enzyme. Clinical monitoring for adverse effects is recommended during coadministration. Compared with placebo, it also significantly reduced craving as measured on an obsessive-compulsivedrinking scale. Monitor liver function tests for hepatotoxicity. Patients should carry identification cards describing the symptoms of a reaction and the persons to notify in case of an emergency. Data appears to be limited to one report; the incidence of the interaction is uncertain, but apparently quite small. Available only in an injectable form (outside of research) to treat opiate overdose. Mild reactions may occur in the sensitive individual when the blood alcohol concentration is increased to as little as 5 to 10 mg/100 mL. Do not breast feed while taking this drug. Outcomes in favor of acamprosate included fewer patients returning to drinking (68 versus 80 percent, NNT = 8) and higher percentage of days of total abstinence (54 versus 38 percent, NNT = 7).10. When metronidazole and disulfiram are combined, symptoms may become evident within 10 to 14 days, and symptoms may remain for 2 to 3 days after the drugs are discontinued. For example, a 5-day oral aprepitant regimen increased the AUC of another CYP3A4 substrate, midazolam (single dose), by 2.3-fold on day 1 and by 3.3-fold on day 5. Disulfiram [Internet]. Increased disulfiram activation may occur if these drugs are administred together. Terbinafine: (Moderate) Due to the risk for terbinafine related adverse effects, caution is advised when coadministering disulfiram. Acetaminophen; Caffeine; Dihydrocodeine: (Moderate) Disulfiram has been shown to inhibit caffeine elimination. (Moderate) Disulfiram has been shown to inhibit caffeine elimination. The economic cost of alcohol abuse and dependence was estimated at more than $184 billion for 1998.1 Use of screening tools and brief primary care interventions for alcohol problems significantly reduces drinking levels in problem drinkers who are not yet alcohol dependent.2 Counseling and 12-step structured treatment programs have been the mainstays of alcohol dependence treatment, whereas pharmacologic treatments traditionally have played an adjunctive role. This interaction may not occur if disulfiram therapy is initiated prior to beginning phenytoin, but, in this scenario, if disulfiram therapy is discontinued, subtherapeutic phenytoin concentrations can ensue. UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/109180/all/disulfiram Ask your health care professional if you have any questions about this. Sertraline: (Major) The ingestion of ethanol by patients receiving disulfiram causes an extremely unpleasant reaction that can last from 30 minutes to several hours. The unpleasant reaction that occurs in patients is believed to be related to the increased serum concentrations of acetaldehyde. Administration of ethanol-containing formulations of cyclosporine to patients receiving or who have recently received disulfiram may result in disulfiram-like reactions. The use of disulfiram remained stable in private programs with 30% of programs reporting use at Wave 1 and 29.6% of programs reporting use at Wave 2. Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug, hypotension to shock level arrhythmias, acute congestive failure, Marked respiratory depression, unconsciousness, convulsions, sudden death. (Moderate) Although the injection of alcohol used for therapeutic procedures is not expected to produce significant systemic effects of ethanol, use caution with concomitant use of disulfiram. Lidocaine; Prilocaine: (Moderate) Concomitant use of systemic lidocaine and disulfiram may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Antabuse is sometimes given for up to several months or years. Additive effects can occur if it is administered concomitantly with other neurotoxic medications including imipenem; cilastatin. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Dronabinol: (Major) Dronabinol oral solution is contraindicated for use within 14 days of disulfiram. In a 12-week double-blind RCT4 of actively drinking patients with alcohol dependence, topiramate was more effective than placebo in initiating abstinence (26 percent more abstinent days with topiramate) and in reducing self-reported drinks per day, drinks per drinking day, and heavy drinking days. Adverse events were not noted during this pharmacokinetic study, however, the decrease in caffeine clearance could be significant in some patients, including some patients with cardiovascular disease. Protozoan infections are common in tropical areas. Disulfiram is a carbamate derivative used to treat alcohol addiction. Disulfiram is a substrate of CYP3A; grazoprevir is a weak CYP3A inhibitor. A1 - Sanoski,Cynthia A, They also had a greater percentage of days of abstinence (70 versus 50 percent with placebo) and a greater total number of days abstinent per study week (6.7 versus 5.9 with placebo) in patients with early-onset alcoholism. Objective To determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care. Adjunct in treatment of the patient with chronic alcoholism who sincerely wants to maintain sobriety. In addition, disulfiram may inhibit some of the CYP450 isoenzymes involved in tricyclic antidepressant metabolism, although the clinical significance is unknown. Atazanavir is a CYP3A4 inhibitor, while disulfiram is a CYP3A4 substrate. Bendamustine: (Major) Consider the use of an alternative therapy if disulfiram treatment is needed in patients receiving bendamustine. Disulfiram is known to inhibit some of the hepatic cytochrome P450 isoenzymes involved in cyclic antidepressant metabolism. As a single 125 mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1.5-fold and 1.2-foldy, respectively. Hypersensitivity and hematological disease have been reported during the administration of disulfiram. Adjust finererone dosage as needed. Clinical monitoring for adverse effects is recommended during coadministration. This medicine can help keep you from drinking because of the unpleasant side effects that will occur if you consume alcohol while taking Antabuse. disulfiram nursing interventions Monitor liver function tests at baseline, after 10-14 days of therapy, and periodically thereafter. Davis Company A similar interaction may occur with fosphenytoin or ethotoin. Bortezomib: (Minor) Monitor patients for the development of peripheral neuropathy when receiving bortezomib in combination with other drugs that can cause peripheral neuropathy like disulfiram; the risk of peripheral neuropathy may be additive. Posaconazole: (Moderate) Posaconazole and disulfiram should be coadministered with caution due to an increased potential for disulfiram-related adverse events. Monitor patients for adverse effects of disulfiram. Increased disulfiram activation may occur if these drugs are administred together. Clinical monitoring for adverse effects is recommended during coadministration. The safe use of disulfiram in pregnancy has not been established. disulfiram Nursing Considerations & Management, Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams), Antiviral Drugs Nursing Considerations & Management, cefprozil Nursing Considerations & Management, rosiglitazone maleate Nursing Considerations & Management, hyoscine-N-butylbromide Nursing Considerations & Management, lidocaine hydrochloride Nursing Considerations & Management, tramadol hydrochloride Nursing Considerations & Management, Antiarrhythmic Drugs Nursing Considerations & Management. The economic cost of alcohol abuse and dependence was estimated at more than $184 billion for 1998. Severe CNS adverse effects, including acute delirium, hallucinations, agitation and disorientation occurred after the patient received two different monoamine oxidase inhibitors (MAOI) in combination with disulfiram. Administration of ritonavir oral solution to patients receiving or who have recently received disulfiram may result in disulfiram-like reactions. In contrast, naltrexone, an anticraving agent, reduces relapse rates and cravings and increases abstinence rates. A similar interaction may occur with fosphenytoin or ethotoin. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Pirfenidone: (Major) Discontinue disulfiram prior to beginning pirfenidone because it may increase exposure to pirfenidone. Caffeine elimination decreased by 30 percent in those patients that were not recovering alcoholics and by 24 percent in those patients that were recovering alcoholics. Baseline and follow-up liver function tests (10 to 14 days) are suggested to detect any hepatic dysfunction that may result with disulfiram therapy. Single-dose administration is reported to selectively inhibit CYP2E1 while chronic use has been shown to inhibit CYP2E1 and CYP1A2 metabolism by 95% and 34%, respectively. In addition, disulfiram may inhibit some of the CYP450 isoenzymes involved in tricyclic antidepressant metabolism, although the clinical significance is unknown. It is not known whether Antabuse passes into breast milk or if it could harm a nursing baby. Antabuse blocks an enzyme that is involved in processing alcohol. Monitor for evidence of hepatotoxicity if coadministration is necessary. During disulfiram therapy, patients may need to limit their caffeine intake if nausea, nervousness, tremor, restlessness, palpitations, or insomnia complaints occur. Aspirin, ASA; Omeprazole: (Moderate) Monitor patients to determine if it is necessary to adjust the dose of disulfiram when taken concomitantly with omeprazole. Family physicians also may consider the use of an SSRI in the presence of a comorbid mood disorder. Caffeine elimination decreased by 30 percent in those patients that were not recovering alcoholics and by 24 percent in those patients that were recovering alcoholics. Coadministration of pazopanib and disulfiram, a CYP3A4 substrate, may cause an increase in systemic concentrations of disulfiram. A disulfiram reaction would not be expected to occur with non-ethanol containing formulations. signs of liver problems including nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Arrange for treatment with antihistamines if skin reaction occurs. Disulfiram usually is given in a dosage of 250 mg per day with a maximum dosage of 500 mg per day. Serotonergic and anticonvulsant agents promise to play more of a role in the treatment of alcohol dependence. When metronidazole and disulfiram are combined, symptoms may become evident within 10 to 14 days, and symptoms may remain for 2 to 3 days after the drugs are discontinued. Working to stop alcohol use to improve quality of life is the main treatment goal. To date, three medicationsdisulfiram (Antabuse), naltrexone (Trexan), and acamprosate (Campral)have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence, and only about 20 percent of eligible patients receive them. Used in management of ethanol abuse. Chlordiazepoxide; Amitriptyline: (Moderate) Disulfiram competes for the binding sites on hepatic cytochrome P-450 with benzodiazepines that undergo oxidative metabolism, including chlordiazepoxide, thereby slowing the metabolism of benzodiazepines and increasing their steady-state plasma concentrations. T1 - disulfiram Short-term outcomes in favor of naltrexone included fewer patients relapsing to alcohol dependence (38 versus 60 percent with placebo), fewer patients returning to drinking (61 versus 69 percent), reduced cravings for alcohol, and fewer drinking days.5 The data showed one relapse was prevented for every five patients treated with naltrexone (i.e., number needed to treat [NNT] = 5). Imipramine: (Moderate) Limited data suggest that the combination of tricyclic antidepressants with disulfiram can produce transient delirium. Hepatotoxicity is a rare but potentially fatal adverse effect.8 Some experts recommend that baseline liver function tests should be obtained, with repeat testing at two weeks, three months, six months, and then every six months thereafter. Disulfiram will add to the effects of other CNS depressants (medicines that slow down the nervous system . In severe reactions there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. This list is not complete and other drugs may interact with disulfiram, including prescription and over-the-counter medicines, vitamins, and herbal products. Antabuse should never be given to a person without his or her knowledge of taking the medicine. Voriconazole: (Moderate) Voriconazole is metabolized by the CYP2C9 isoenzyme, and drugs that are known to be inhibitors of CYP2C9, such as disulfiram, may theoretically lead to elevated plasma levels of voriconazole when coadministered. In addition, disulfiram may inhibit some of the CYP450 isoenzymes involved in tricyclic antidepressant metabolism, although the clinical significance is unknown. Antabuse is used together with therapy and counseling support to help you stop drinking. Diazepam: (Moderate) Disulfiram may compete for the binding sites on hepatic cytochrome P-450 (CYP) with benzodiazepines that undergo oxidative metabolism such as diazepam, thereby slowing the metabolism of diazepam and increasing its steady-state plasma concentrations. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. This reaction would not be expected to occur with oral sulfamethoxazole; trimethoprim. Other SSRIs have shown similar results.14 Studies on the effect of SSRIs in patients with more severe alcohol dependence (Type B according to the classification system by Babor and colleagues15) show no clear benefit and sometimes show trends toward worse outcomes with SSRIs,16 and studies involving patients with less severe alcohol dependence (Babor Type A15) show no consistent benefit.17. Plasma concentrations and efficacy of disulfiram may be reduced if these drugs are administered concurrently. It is well tolerated with limited side effects, most commonly transient diarrhea (occurring in approximately 10 percent of patients). If used together, monitor patients closely for loss of disulfiram efficacy; a disulfiram dosage adjustment may be required to obtain the desired therapeutic effect. If aminophylline is added after disulfiram is begun and disulfiram is later discontinued, subtherapeutic theophylline serum concentrations can result. Lidocaine is a CYP3A4 and CYP1A2 substrate; disulfiram inhibits CYP1A2. In one RCT,3 ondansetron (Zofran) was shown to significantly reduce self-reported drinking. It is not known if disulfiram crosses the placenta, but the molecular weight of the drug suggests that placental transfer is likely. Tolerance to the drug has not been reported to date. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. You will need frequent blood tests to check your liver function. Use Caution/Monitor. Treat patient with severe disulfiram reaction as though in shock. Pimozide: (Major) Concurrent use of pimozide with CYP1A2 inhibitors such as disulfiram should be avoided if possible. AU - Quiring,Courtney, Identify nursing interventions the nurse should implement for a client who has the electrolyte imbalance, . Disulfiram is a moderate inhibitor of CYP1A2 and a potent inhibitor of CYP2E1. A more recent article on medications for alcohol use disorder is available. mellitus. Disulfiram. Adverse events were not noted during this pharmacokinetic study, however, the decrease in caffeine clearance could be significant in some patients, including some patients with cardiovascular disease. If concomitant use of naltrexone and disulfiram is required, liver function tests should be performed prior to beginning combination therapy, then they should be repeated every 2 weeks for 1 to 2 months. Clinical monitoring for adverse effects is recommended during coadministration. Available for Android and iOS devices. A healthcare physician may administer disulfiram again when the alcohol has been completely eliminated from the body tissues. Download the Nursing Central app by Unbound Medicine, 2. Vallerand, April Hazard., et al. Disulfiram increased the Cmax and the AUC of cocaine by 2- to 3-fold and 3- to 6-fold, respectively, in a study of volunteers with cocaine-abuse histories who received intranasal cocaine after disulfiram. I131; or decreases PBI test results (rare). Patients receiving midazolam should be monitored for signs of altered benzodiazepine response when midazolam is coadministered. Midazolam: (Moderate) Disulfiram may decrease the hepatic oxidative metabolism of benzodiazepines if administered concomitantly. Consuming alcohol after taking disulfiram results in symptoms such as palpitations, flushing, nausea, vomiting, and headache. Relatives of patients receiving the drug should be instructed as to the precautions and risks associated with its use.NOTE: It is important to check the alcohol content of other medications the patient is receiving prior to disulfiram therapy. An evidence report from the Agency for Health-care Research and Quality6 concluded that studies using the disulfiram implant display serious methodologic weaknesses (most substantively, regarding the question of bioavailability), and that the four placebo-controlled RCTs using oral disulfiram produced mixed results. Although not reported with benznidazole, psychotic reactions have been reported in patients concurrently taking disulfiram and other nitroimidazole agents, of which benznidazole is structurally similar to. This is to make sure you are using the medicine as it was prescribed as part of your treatment. Hypersensitivity, CVS diseases; peripheral neuropathy, psychosis. 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