Disulfiram (Antabuse)

Disulfiram (Antabuse)

Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. This agent’s only use is as a deterrent to drinking alcohol in persons receiving treatment for alcoholism. It is useful for persons who are motivated to abstain from drinking and who are not impulsive. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throb-bing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. In severe cases, there may be chest pain, dyspnea, severe hypotension, confusion, and even death. Symptoms progress rapidly and last from 30 minutes to 2 hours. Because the liver metabolizes disul-firam, it is most effective in persons whose liver enzyme levels are within or close to normal range.

Disulfiram inhibits the enzyme aldehyde dehydroge-nase, which is involved in the metabolism of ethanol. Acetaldehyde levels are then increased from 5 to 10 times higher than normal, resulting in the disulfiram–alcohol reaction. This reaction is potentiated by decreased levels of epinephrine and norepinephrine in the sympathetic nervous system caused by inhibition of dopamine beta-hydroxylase (dopamine -hydroxylase) (Cornish, McNicholas, & O’Brien, 2006).

Education is extremely important for the client taking disulfiram. Many common products such as shaving cream, aftershave lotion, cologne, and deodorant and over-the-counter medications such as cough preparations contain alcohol; when used by the client taking disulfiram, these products can produce the same reaction as drinking alcohol. The client must read product labels carefully and select items that are alcohol free.

Other side effects reported by persons taking disulfiram include fatigue, drowsiness, halitosis, tremor, and impo-tence. Disulfiram also can interfere with the metabolism of other drugs the client is taking, such as phenytoin (Dilantin), isoniazid, warfarin (Coumadin), barbiturates, and long-acting benzodiazepines such as diazepam and chlordiazepoxide.

Acamprosate (Campral) is sometimes prescribed for persons in recovery from alcohol abuse or dependence. It helps reduce the physical and emotional discomfort encountered during the first weeks or months of sobriety, such as sweating, anxiety, and sleep disturbances. The dos-age is two tablets (333 mg each) three times a day. Persons with renal impairments cannot take this drug. Side effects are reported as mild and include diarrhea, nausea, flatu-lence, and pruritus.