CONSENT FOR TREATMENT WITH DISULFIRAM
Disulfiram (Antabuse) is an FDA-approved medication to treat alcohol use disorder in individuals who have stopped consuming alcohol. This medication causes the body to be unable process any alcohol. When alcohol is consumed, a dose-dependent reaction occurs.
Disulfiram should NOT be taken if you have consumed alcohol within the past 12 hours. The larger the amount of the alcohol consumed, the stronger the disulfiram-alcohol reaction. The reaction can last from 30 minutes to several hours, or as long as it takes for the alcohol to be metabolized. A disulfiram-alcohol reaction may occur for up to 2 weeks after stopping medication.
A disulfiram-alcohol reaction may include trouble breathing, throbbing pain in head and neck, nausea, vomiting, sweating, thirst, palpitations, weakness, dizziness, blurred vision, and confusion. Severe reactions may involve respiratory failure, heart failure, unconsciousness, seizure, and death.
Even very small doses of alcohol can be absorbed from perfume, hand sanitizer, food items (dressings, vinegars, marinades, sauces, extracts, etc.), and alcoholic beverages, causing a disulfiram-alcohol reaction. It is important to check labels of items that will go in or on your body. Laboratory testing to monitor liver function will be completed before and during treatment, as disulfiram can affect your liver. Contact your provider immediately if you develop symptoms such as yellowing of eyes/skin, dark urine, stomach pain, loss of appetite, fatigue, and change in stool (including the development of diarrhea).
The most common side effect of disulfiram is drowsiness, but severe adverse reactions have occurred in some individuals including liver failure, nerve irritation/neuropathy, psychosis, acne, skin rash, impotence, and inflammation of the optic nerve. There are some medications that should not be taken with disulfiram (i.e., metronidazole, dronabinol, and certain cough medicines). It is important to let your providers know that you are prescribed disulfiram. Do not change your medications without checking with your provider. It is not known if disulfiram is safe during pregnancy or if it can be passed into breast milk. A pregnancy test will be done before treatment begins. If you learn you are pregnant at any time please alert your medical team. Store disulfiram at room temperature, in a light-resistant container. Keep all out of the reach of children and pets.
Alcohol use is very dangerous after starting disulfiram treatment. It is recommended to alert your family, friends and close contacts that you are on disulfiram and about the risk of a severe reaction should you have a return to use.
I have read and understood the possible effects and adverse effects of medications and consent to take the medication.
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