From the Guidelines
A key patient counseling point for disulfiram (Antabuse) therapy is that ingestion of alcohol while taking this medication may cause flushing, nausea, sweating, chest pain, and shortness of breath. This is because disulfiram blocks the enzyme aldehyde dehydrogenase, causing acetaldehyde to accumulate in the bloodstream when alcohol is consumed, leading to a severe and potentially dangerous reaction. According to the most recent and highest quality study available 1, disulfiram is not recommended for use in patients with alcoholic liver disease (ALD) due to the risk of hepatotoxicity. Other studies also support this warning, including a 2013 study published in the Clinical and Molecular Hepatology journal 1 and a 2012 study published in the Journal of Hepatology 1, which highlight the potential risks and limitations of disulfiram therapy. Some key points to emphasize to patients include:
- Avoiding all alcohol consumption while taking disulfiram and for at least 14 days after discontinuing it
- Being aware of hidden sources of alcohol in foods, medications, and other products
- Carrying identification indicating they are taking disulfiram in case of emergency situations
- Understanding the potential severity of the disulfiram-alcohol reaction, which can occur within 10-30 minutes of alcohol consumption and last several hours. Overall, patient counseling should prioritize the potential risks and consequences of disulfiram therapy, particularly in relation to alcohol consumption.
From the FDA Drug Label
The patient must be fully informed of the disulfiram-alcohol reaction He must be strongly cautioned against surreptitious drinking while taking the drug, and he must be fully aware of the possible consequences. He should be warned to avoid alcohol in disguised forms, i.e., in sauces, vinegars, cough mixtures, and even in aftershave lotions and back rubs. The Disulfiram-Alcohol Reaction Disulfiram plus alcohol, even small amounts, produce flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion
A key patient counseling point regarding disulfiram therapy for Alcohol Use Disorder (AUD) is that ingestion of alcohol while taking this medication may cause severe reactions, including flushing, nausea, sweating, chest pain, and shortness of breath. Patients should be warned to avoid alcohol in all forms and informed of the possible consequences of an accidental disulfiram-alcohol reaction 2.
From the Research
Key Patient Counseling Points for Disulfiram Therapy
- A key patient counseling point regarding disulfiram therapy for Alcohol Use Disorder (AUD) is that ingestion of alcohol while taking this medication may cause adverse reactions, including flushing, nausea, sweating, chest pain, and shortness of breath 3, 4.
- Patients must clearly understand the risks of drinking while taking disulfiram and the importance of continued clinical supervision and monitoring for efficacy and side effects 3.
- Disulfiram is only an adjunctive therapy, and continued support, supervision, and other therapeutic measures are required for effective treatment 3.
- The medication should not be prescribed without accompanying education, counseling, and concomitant alcoholism therapy 3, 5.
- Patients should be informed that disulfiram can produce an aversive reaction with ethanol, usually at a dose between 250 mg/day and 500 mg/day, and that cardiac, hepatic, and neurologic toxicity can also occur within this dosage range 3.