Antabuse (disulfiram 200mg)

Antabuse general information

What is Antabuse used for?

Antabuse tablets 200mg are used to treat and manage chronic alcohol dependence as part of an integrated programme of counselling and rehabilitation, to help alcoholics remain alcohol free once they have given up drinking alcohol.  Alcohol dependence or alcoholism is considered an addictive disease that can result in physical and psychological addiction to alcohol that can influence all aspects of life, causing dysfunctional behaviour and affecting relationships and the workplace.  Alcoholism has recognisable symptoms, including inability to stop drinking, the need to drink more for the same effect, craving alcohol above anything else and withdrawal symptoms, such as anxiety, sweating, tremor, tachycardia (increased pulse rate and, nausea, if the interval between drinks increases or attempts are made to give up drinking.  Antabuse tablets 200mg help break the habit of alcohol dependency by acting as a deterrent to drinking alcohol, but will only work as part of a supportive programme and requires commitment and motivation to remain alcohol free.  ^{1, 2}

Our attention has been drawn to an article written by Daniel A. Kinderlehrer MD, where Antabuse (Disulfiram) has an off-label use in the treatment of Lyme disease. Laboratory studies conducted at Stanford University showed Disulfiram as the most potent agent out of twenty, against Borrelia burgdorferi, the microorganism considered responsible for Lyme disease.
It should be noted with caution that positive laboratory studies do not always translate into effective treatments in the human body. However, the results are encouraging and warrant further study. As always, when considering a new medical treatment option, advice should be sought from your doctor before proceeding.

How does Antabuse work?

Antabuse tablets 200mg contain disulfiram, a prodrug that is rapidly metabolised to diethyldithiocarbamate (DDC) and works by blocking the metabolism of alcohol, which produces an acute sensitivity to alcohol with unpleasant side effects.  Alcohol is normally metabolises in the liver to acetaldehyde by the action of the enzyme alcohol dehydrogenase and acetaldehyde is further metabolised to acetic acid by the action of the enzyme acetaldehyde dehydrogenase.  Disulfiram in Antabuse tablets 200mg inhibits the action of acetaldehyde dehydrogenase, resulting in the build-up of acetaldehyde, which is responsible for the unpleasant symptoms associated with excess alcohol consumption and the hangover effect.  It is also thought that Disulfiram in Antabuse tablets 200mg has other metabolic effects that contribute to the unpleasant reactions associated with treatment with Antabuse tablets 200mg including flushing of the face, a feeling of difficulty in breathing, palpitations, a throbbing headache, nausea and vomiting.  These effects are intended to act as a deterrent to continued alcohol abuse and can last for several hours and up to three weeks after Antabuse tablets 200mg is no longer taken.

What does Antabuse contain?

Antabuse tablets 200mg contains the active ingredient disulfiram, used to treat alcohol dependence.  They also contain povidone, microcrystalline cellulose, talc, tartaric acid, colloidal anhydrous silica, sodium bicarbonate, maize starch and magnesium stearate. 

Treating alcohol dependence with Antabuse

Antabuse tablets 200mg contains disulfiram that is used to treat alcohol dependence as part of an integrated programme of counselling and rehabilitation, to help alcoholics remain alcohol free once they have given up drinking alcohol.  Alcohol dependence or alcoholism is an addictive disease that causes dysfunctional behaviour affecting all aspects of life including, relationships and the workplace and has recognisable symptoms, including inability to stop drinking, the need to drink more for the same effect, craving alcohol above anything else and withdrawal symptoms, such as anxiety, sweating, tremor, tachycardia (increased pulse rate), nausea, if the interval between drinks increases or attempts are made to give up drinking.  Disulfiram in Antabuse tablets 200mg works by blocking the metabolism of alcohol, which produces unpleasant reactions if alcohol is ingested and include flushing of the face, a feeling of difficulty in breathing, palpitations, a throbbing headache, nausea and vomiting.  These reactions are intended to act as a deterrent to continued alcohol abuse and can last for several hours and up to three weeks after Antabuse 200 is no longer taken.  Antabuse tablets 200mg should only be used as an aid to giving up alcohol as part of an overall supportive programme.

What are the side effects of Antabuse?

The most commonly reported side effects when taking Antabuse tablets 200mg include, drowsiness, fatigue, numbness, tingling, pain or weakness in hands or feet (peripheral neuritis, polyneuritis), peripheral neuropathy, skin rash, eye pain or tenderness and changes in vision (optic neuritis), mood and changes, jaundice, impotence, headache, stomach upset, bad breath (halitosis), dizziness.

When should Antabuse not be used?

You should not use Antabuse tablets 200mg if you:

• are allergic to disulfiram or any ingredients in Antabuse
• are sensitive to other thiuram derivatives used in pesticides and rubber production
• are pregnant or are breastfeeding
• have kidney or liver disease
• have consumed alcohol within 24 hours
• have used any alcohol-containing food, sauces, remedies, tonics, toiletries, perfumes or sprays within the previous 24 hours
• have severe heart disease or heart failure
• have had a stroke or other serious brain disorder
• have a mood or personality disorder
• are taking medicines that interact with Antabuse, including phenytoin for seizures, isoniazid for tuberculosis treatment, benzodiazepines like diazepam for anxiety, the antibiotic metronidazole, anticoagulants like warfarin, the sedative paraldehyde.

What medications interact with Antabuse?

Several medications interact with Antabuse tablets 200mg and should either not be taken while you are taking Antabuse or only after discussion and instruction from your doctor:  

• Drugs that cause a serious reaction with Antabuse: isoniazid for tuberculosis treatment, the antibiotic metronidazole, the sedative paraldehyde
• Drugs that are affected by Antabuse: phenytoin for seizures, benzodiazepines like diazepam for anxiety, anticoagulants like warfarin

How should Antabuse be taken?

You should begin your treatment with Antabuse tablets 200mg only after you have stopped drinking any alcohol for at least 24 hours before the first dose.  You should take your Antabuse tablets 200mg dissolved in a quarter glass of water or fruit juice, preferably on waking in the morning, and drink immediately.  If the prescribed dose has a sedative effect you can take your Antabuse tablets 200mg at bedtime.  The dose you take will be reduced after the first few days and then you should continue to take your Antabuse tablets 200mg for as long as recommended by your doctor, usually from 6 weeks up to 6 months.

How long should you take Antabuse?

You should continue to take your Antabuse tablets 200mg for as long as recommended by your doctor, usually from 6 weeks up to 6 months.

Missed dose of Antabuse

If you miss a dose of Antabuse take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Antabuse be stored?

You should store your Antabuse below 25°C in a cool dry place. 

References

1. Krampe H, Stawicki S, Wagner T, Bartels C, Aust C, Rüther E, Poser W, Ehrenreich H.  Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome.  Alcohol Clin Exp Res 2006; 30: 86-95.
2. Jørgensen CH, Pedersen B, Tønnesen H. The efficacy of disulfiram for the treatment of alcohol use disorder. Alcohol Clin Exp Res 2011; 35:1749-58