Antabuse (Disulfram)

What does it do :
Antabuse is a drug that reacts with alcohol leading to an accumulation of acetaldehyde in your body. This makes you very unwell. The symptoms are flushing, nausea, vomiting, palpitations, headache, and hypotension. The reaction to ingestion of alcohol when someone has taken Disulfiram is sometimes very severe and very occasionally fatal. Onset of the reaction occurs within minutes and lasts several hours.

Who should take it :
Antabuse should only be taken by people with major alcohol related problems when other interventions are inadequate. It is most successful when used by people with relatively high motivation to abstain completely and in those who accept supervision of medication. Supervision is not essential but most who do not accept supervision comply poorly.

Who should not take it :
People with major personality disorders, or who are highly impulsive; people with a history of self harm; people who are using drugs as well as alcohol; people with cardio-vascular disease or hypotension.

Prescribing Guidelines :
Antabuse should initially by prescribed by a consultant psychiatrist.
It should be started 24 hours after the last drink or zero breathalyser reading.

Dosage :
Day 1 800mg
Day 2 600mg
Day 3 400mg
Thereafter the maintenance dose is normally 200mg daily, although doses up to 400mg daily can be given where consumption of alcohol on 200mg does not lead to adverse reaction.
It can be given on alternate days.
Duration of treatment is normally 6 -12 months.
No alcohol for 7 days after discontinuation.

Side Effects :
Usually Antabuse is well tolerated. However the following possible side effects have been noted:
Tiredness
Nausea
Hepatoxicity (rare, peak 2 months)
Peripheral neuropathy (cumulative and dose related)
Rash (peak 2 weeks)
Psychosis

Contraindications :
Severe heart, liver, kidney, lung disease
Diabetes
Psychosis
Epilepsy
Organic brain disease
Neuropathy
Pregnancy

Monitoring :
Check liver function tests monthly for 4 months.