effect of celecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.chlordiazepoxideMinor (1)disulfiram increases levels of chlordiazepoxide by decreasing metabolism. Minor/Significance Unknown.cholic acidMonitor Closely (1)disulfiram increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.clonazepamMonitor Closely (1)disulfiram increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.clorazepateMonitor Closely (1)disulfiram increases levels of clorazepate by decreasing metabolism. Use Caution/Monitor.cocaine topicalMonitor Closely (1)disulfiram increases levels of cocaine topical by unknown mechanism. Use Caution/Monitor.dapsoneMinor (1)disulfiram will increase the level or effect of dapsone by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.diazepamMonitor Closely (1)disulfiram increases levels of diazepam by decreasing metabolism. Use Caution/Monitor.diclofenacMinor (1)disulfiram will increase the level or effect of diclofenac by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.dronabinolContraindicated (1)disulfiram increases toxicity of dronabinol by aldehyde dehydrogenase inhibition. Contraindicated. Dronabinol oral solution (Syndros) contains 50% (w/w) dehydrated alcohol 5.5% (w/w) propylene glycol, which can produce disulfiramlike reactions if coadministered. Discontinue disulfiram at least 14 days before starting dronabinol solution and do not administer disulfiram within 7 days of completing treatment with dronabinol solution.eliglustatContraindicated (1)disulfiram increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.ethanolSerious - Use Alternative (2)disulfiram will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug. disulfiram increases toxicity of ethanol by decreasing metabolism. Contraindicated. Enhanced CNS & cardiac toxicity.ethotoinMonitor Closely (1)disulfiram will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.Minor (1)disulfiram increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.etravirineMonitor Closely (1)disulfiram will increase the level or effect of etravirine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.fezolinetantContraindicated (1)disulfiram will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitorsfinerenoneMonitor Closely (1)disulfiram will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.flibanserinMonitor Closely (1)disulfiram will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.flurbiprofenMinor (1)disulfiram will increase the level or effect of flurbiprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.fluvastatinMinor (1)disulfiram will increase the level or effect of fluvastatin by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.fosphenytoinMonitor Closely (1)disulfiram will increase the level or effect of fosphenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.Minor (1)disulfiram increases levels of fosphenytoin by decreasing metabolism. Minor/Significance Unknown.green teaMonitor Closely (1)disulfiram increases levels of green tea by decreasing elimination. Use Caution/Monitor. Combination may increase caffeine levels. Caution should be taken due to increased risk of adverse effects due to caffeine in green tea.ibuprofenMinor (1)disulfiram will increase the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.ibuprofen IVMinor (1)disulfiram will increase the level or effect of ibuprofen IV by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.isavuconazonium sulfateMonitor Closely (1)disulfiram will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.isocarboxazidMinor (1)disulfiram, isocarboxazid. Mechanism: unknown. Minor/Significance Unknown. Risk of delirium (case report).isoniazidMonitor Closely (2)disulfiram will increase the level or effect of isoniazid by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. isoniazid increases toxicity of disulfiram by decreasing metabolism. Use Caution/Monitor. Enhanced CNS toxicity.ivacaftorMonitor Closely (1)disulfiram increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .lemborexantMonitor Closely (1)disulfiram will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.linezolidMinor (1)disulfiram, linezolid. Mechanism: unknown. Minor/Significance Unknown. Risk of delirium (case report).lomitapideMonitor Closely (1)disulfiram increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.lonafarnibSerious - Use Alternative (1)disulfiram will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.meloxicamMinor (1)disulfiram will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.metronidazoleSerious - Use Alternative (1)disulfiram increases toxicity of metronidazole by decreasing metabolism. Contraindicated. Enhanced CNS & cardiac toxicity.metronidazole topicalMinor (1)disulfiram increases toxicity of metronidazole topical by decreasing metabolism. Minor/Significance Unknown. Enhanced CNS & cardiac toxicity with oral metronidazole and disulfiram; less likely to occur with topical administration because of low absorption.metronidazole vaginalMinor (1)disulfiram increases toxicity of metronidazole vaginal by decreasing metabolism. Minor/Significance Unknown. Enhanced CNS & cardiac toxicity with oral metronidazole and disulfiram; less likely to occur with vaginal administration because of low absorption.midazolam intranasalMonitor Closely (1)disulfiram will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.oliceridineMonitor Closely (1)disulfiram will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. pexidartinibSerious - Use Alternative (1)disulfiram and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.phenelzineMinor (1)disulfiram, phenelzine. Mechanism: unknown. Minor/Significance Unknown. Risk of delirium (case report).phenytoinMonitor Closely (1)disulfiram will increase the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.Minor (1)disulfiram increases levels of phenytoin by decreasing metabolism. Minor/Significance Unknown.piroxicamMinor (1)disulfiram will increase the level or effect of piroxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.procarbazineMonitor Closely (1)disulfiram, procarbazine. Mechanism: unknown. Use Caution/Monitor. Risk of delirium (case report).ramelteonMinor (1)disulfiram will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.ritonavirContraindicated (1)disulfiram increases toxicity of ritonavir by aldehyde dehydrogenase inhibition. Contraindicated. Interaction only associated with oral solution, which contains 42% alcohol.ruxolitinibMinor (1)disulfiram will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ruxolitinib topicalMinor (1)disulfiram will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.selinexorSerious - Use Alternative (1)selinexor, disulfiram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sevofluraneMinor (1)disulfiram will increase the level or effect of sevoflurane by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.sulfamethoxazoleMinor (1)disulfiram will increase the level or effect of sulfamethoxazole by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.tamsulosinMonitor Closely (1)disulfiram increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tazemetostatMonitor Closely (1)disulfiram will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.theophyllineMinor (1)disulfiram increases levels of theophylline by decreasing metabolism. Minor/Significance Unknown.tinidazoleSerious - Use Alternative (1)tinidazole increases toxicity of disulfiram by aldehyde dehydrogenase inhibition. Avoid or Use Alternate Drug. Alcoholic beverages and preparations containing ethanol or propylene glycol should be avoided during tinidazole therapy and for 3 days afterward because abdominal cramps, nausea, vomiting, headaches, and flushing may occur. Tinidazole should not be given to patients who have taken disulfiram within the last two weeks. .tipranavirSerious - Use Alternative (1)disulfiram, tipranavir. Mechanism: decreasing metabolism. Avoid or Use Alternate Drug. Risk of disulfiram reaction (tipranavir capsules contain alcohol).tolbutamideMinor (1)disulfiram will increase the level or effect of tolbutamide by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.tranylcypromineMonitor Closely (1)disulfiram, tranylcypromine. Mechanism: unknown. Use Caution/Monitor. Possible CNS delirium including agitation, visual hallucinations, and disorientation may occur. .triazolamMonitor Closely (1)disulfiram increases levels of triazolam by decreasing metabolism. Use Caution/Monitor.valoctocogene roxaparvovecMonitor Closely (1)disulfiram and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.voriconazoleMinor (1)disulfiram will increase the level or effect of voriconazole by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown. Frequency Not Defined Fatigue Headache Impotence Metallic aftertaste Acneiform eruptions Polyneuritis Rash Hepatitis Peripheral neuropathy Optic neuritis Psychotic disorder Black Box Warnings Never administer to a patient in a state of alcohol intoxication or without patient's full knowledge Instruct patient's relatives accordinglyContraindications Ethanol, metronidazole, paraldehyde, any alcohol-containing products (e.g., some mouthwashes) Severe cardiac disease Coronary occlusion Psychosis Hypersensitivity Cautions When EtOH ingested by patient taking disulfiram: flushing, throbbing HA, N/V, diaphoresis, thirst, SOB, syncope, vertigo, blurred vision, confusion; respiratory depression, cardiac arrhythmias, MI or liver failure may occur Use caution in diabetes, hypothyroidism, seizures, nephritis, hepatic impairment Severe hepatitis and/or hepatic failure has been associated with therapy even in patients without prior history of abnormal hepatic function Pregnancy Category: C Lactation: excretion in milk unknown/not recommendedPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Produces sensitivity to EtOH via blocking its oxidation at acetaldehyde stage, resulting in unpleasant reactions including palpitations, hypotension, chest pain, nausea, vertigo, thirst, flushing, and nausea Absorption Peak plasma time: 4 hr Peak plasma concentration: 2.4 mcg/mL Duration: up to 2 wk Onset: 2-12 hr Metabolism Hepatic 80-90% Metabolites: Diethyldithiocarbamate Enzymes inhibited: hepatic CYP2C9, CYP2E1 Elimination Excretion: Feces and exhaled gases BRAND FORM. UNIT PRICE PILL IMAGE disulfiram oral- 250 mg tabletdisulfiram oral- 500 mg tabletdisulfiram oral- 250 mg tabletdisulfiram oral- 500 mg tabletdisulfiram oral- 250 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationdisulfiram oral DISULFIRAM - ORAL (dye-SUL-fi-ram) COMMON BRAND NAME(S): Antabuse WARNING: This medication should not be given to a patient without their knowledge. Do not take this medication if you are under the influence of alcohol or have drunk alcohol in the last 12 hours. USES: This medication is used along with counseling and support to treat alcoholism. Disulfiram works by blocking the processing of alcohol in the body. This causes you to have a bad reaction when you drink alcohol. HOW TO USE: See also Precautions section.Take this medication by mouth with or without food as directed by your doctor, usually once daily in the morning. If this medication causes drowsiness, take it at bedtime.The dosage is based on your medical condition and response to treatment.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. SIDE EFFECTS: Drowsiness, tiredness, headache, acne, and metallic/garlic-like taste in the mouth may occur as your body gets used to the medication. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Tell your doctor right away if you have any serious side effects, including: decreased sexual ability, vision changes, numbness/tingling of arms/legs, muscle weakness, mental/mood changes (such as agitation, confusion, extreme excitement), seizures.This drug may rarely cause serious (rarely fatal) liver disease. If you notice any of the following serious side effects, tell your doctor right away: nausea/vomiting that doesn't stop, severe stomach/abdominal