Prescribing Disulfiram
Initial screening should take place to see if the patient is appropriate for disulfiram (antabuse) therapy. The concomitant conditions that lead to disulfiram-alcohol reactions are diabetes, epilepsy, nephritis, hypothyroidism, brain damage, cirrhosis, and hepatic problems. Baseline and follow-up Transamine tests 10 to 14 days later are suggested in order to detect possible hepatic dysfunction. In addition, complete blood count and Sequential Multiple Analysis-12 test (SMA-12) should be administered every 6 months.
Disulfiram can be initiated when the patient has been alcohol free for a minimum of 36 hours (but preferably 4 to 5 days) since significant reactions occur in individuals who have a blood alcohol concentration (BAC) of as little as .05%. The prescribing physician and patient should be aware of less obvious sources of alcohol, such as cough syrups, food sauces, confections, pain medications, mouth wash, and externally applied aftershaves and lotions that may lead to an adverse reaction.
>Dosage and Duration
Dosing of disulfiram can range between 125 mg/day to 500 mg/day. Initiation usually begins with 500 mg daily (preferably in the morning) for the first two weeks. Some physicians prefer to initiate disulfiram therapy at 125 mg/day (one half tablet). They argue that at this lower dosage, the risk of severe reaction is lessened if the patient relapses and the medication cost is diminished.
After initiation, a daily maintenance dose of approximately 250 mg should be given (not to exceed 500 mg daily). The maintenance phase continues until the patient obtains sobriety and self control. Although individuals vary, frequently, the maintenance phase lasts for several months or years.
Regardless of what dosage a physician chooses, all physicians should complete a Disulfiram Checklist, and patients receiving treatment should carry Identification Cards stating that they are currently receiving disulfiram.
Precautions
As a general rule, pregnant and breast feeding women should not be prescribed disulfiram. Previous animal studies involving disulfiram, reproduction, and lactation provided mixed results. One study showed deleterious effects on the reproductive cycle of female rats, while another did not. If a breast feeding mother must undergo disulfiram treatment, then she should cease nursing while taking the drug.