Interacting drugs- summary

Disulfram +

Alcohol-                                                                                                                                   Dusulfran causes a severe alcohol-intolerance reaction. Avoid alcohol in all forms 

Benzodiazipines-                                                                                                         Disulfran decreases the plasma clearance of benzodiazepines metabolized by oxidation, resulting in increased CNS depression When benzodiazepine therapy is indicated , use oxazepam, alprazolam, or lorazepam, since they are metabolised by glucoronidation 

Caffeine-                                                                                                               cardiovascular and CNS stimulation effects of caffeine may be increased by disulfram

Hydantoins-                                                                                                                     serum hydantoin levels may be increased by disulfran, resulting in increased pharmacologic and toxic effects. Monitor hydantoin levels and adjust dosage as needed 

Isoniazid-                                                                                                                             observe patients receiving isoniazid and disulfran for the appearance of unsteady gait,or marked changes inbehaviour Discontinue Disulfran or reduce dose if such signs appear. 

Metronidazole-                                                                                                             Patients may exhibit acute toxic psychosis or confusional state when taking metronidazole in combination with disulfran, requiring discontinuation of one or both of these agents

Tricyclic antidepr-                                                                                                               and disulfran coadmin. may result in acute organic brain syndrome Bioavailbility of antidepressant may also be increased 

Warfarin-                                                                                                                      disulfran may increase the anticoagulant effect of warfarin. Monitor prothrombin time and adjust the warfarin dosage as necessary

Enhances action of chlordiazepoxide, dizepam, phenytoin, isoniazide, anticoagulants.

Disulfiram-alcohol interaction: Intense flushing of neck and face, accompanied by heat and sweating, tachycardia, palpitation, dysponea, dizziness, headache.

Hypertension initially and then hypotension. GI disturbances, exhaution, sleep, convulsions, cardpulminory arrest.

Psychosis may be precipitated with concurrent metronidazole therapy.

Tricyclic antidepressants exaceberate symptoms of Disulfiram-alcohol reaction.

Management of selected chronic alchoholics

Rare M.I., cerebrovascular haemorrhage and infarction.

Drowsiness, lassitude, psychotic reactions, Peripheral neuropathy, Optic neuritis and atrophy convulsions, Hepatotoxicity.

CVS disease,peripheral neuropathy,pregnancy,psychosis.

Special precautions:

Not for patients in state of alcohol intoxication, diabetes, epilepsy, hepatic/renal impairment, hypothyroidism, cerebral damage.

Indications:

Management of selected chronic alchoholics

Dosage:

Do not administer until the patient has abstained from alcohol for atleast 12 hours. Initial- 500mg daily as a single dose for 1 or 2 weeks.

Take at bed time if required. Maintenance- 250mg daily but not to exceed 500mg.

1. Do not take for at least for 12 hours after drinking alcohol. A reaction may occur for upto 2 weeks after disulfram has been stopped.

2. Avoid alcohol in all forms.

3. Always read product lables and asertain alcohol content of all liquid medications before choosing one.

4. Tablets can be crushed or mixed with liquid.

5. May cause drowsiness. Use caution while driving or performing other tasks requiring alertness.

6. The alcohol disulfram reaction can have serious effects on the heart and respiratory systems.

7. Alway carry identification indicating that you are taking disulfram.

8. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to disulram or other related medicines. Also tell your doctor if youn are allergic to any other substances such as foods, preservatives or dyes.

9. Pregnancy-Studies on effects of pregnancy has not been done. However make sure that your doctor knows if you are pregnant or if you may become pregnant before taking digitalis.

3. Breast feeding- disulfiram has not been reported to cause problems in nursing babies.

4. Children- this medicine has not shown to cause different side effects or problems than it does in adults.

5. Elderly- no specific information comparing use of disulram in elderly with use in other age groups.

6. Other medicines- tell your doctor if you are taking any of the following- Anticoagulants - taking disulram may increase the efects of anticoagulants, changing the amount you need to take Ethotion or Mephenytoin or Phenytoin- taking these medicines with disulfram may change the amount of anticonvulsant you need to take Isoniazid - disulfram may increase central nervous system CNS effects, such as dizziness, clumsiness, irritabilty, or trouble in sleeping Metronidazole or Paraldehyde - these medicines should not be taken with or within several days of disulfram because serious side effects may occur

7.Other medical problems- tell your doctor if you have any other medical problems- Asthma or other lung disease or Diabetes mellitus or Epilepsy or seizure disorders or Heart or blood vessel disease or Kidney disease or Liver disease or cirrhosis of the liver or Underactive thyroid - a disulram alcohol reaction may make the condition worse Depression or Severe mental illness -disulfram may make the condition worse Skin alergy- disulfram may cause an allergic reaction

8. Missed dose- If you miss a dose of this medicine take it as soon as possible. However if it is almost time for your next dose go back to your regular dosing schedule. Do not double doses.

None reported.

Pregnancy:

Safety for use during pregnancy has not been established