Disulfiram (Antabuse)
Anti-alcohol (blocks enzyme that metabolizes alcohol’s toxic by-product aldehyde)
- Alcohol
- Reduces cocaine in context of alcohol use disorder
Features
Dosing
Start 500mg/day for 1 week to rev up metabolic-blocking effect, then lower to 250 mg/day as that works just as well and is better tolerated.
Management
Warn patient of potential death with over-drinking on it and severe sickness with any alcohol. Do not drink within 2 wks of stopping it, must be sober 24 hours before starting. Relative contraindications: cardiovascular and cerebrovascular diseases (hypertension and, rarely, heart failure has occurred in these populations), significant hepatic impairment (disulfiram can be hepatotoxic), psychosis (which can worsen on disulfiram), and pregnancy (it is a teratogen).
Can help cocaine when comorbid with alcohol.
EMR Text
Alcohol use disorder
Disulfiram use based on FDA approval in alcohol use disorder.
Disulfiram risks, including toxic interaction with alcohol and timing of the interaction, reviewed with patient.