- No Title 1572552583
- No Title 1572450077
- Description
- Clinical Pharmacology
- Indications And Usage
- Contraindications
- Warnings
- Precautions
- Adverse Reactions
- Overdosage
- Dosage And Administration
- How Supplied
- Package/label Display Panel
- Principal Display Panel - 250 Mg
- Principal Display Panel - 500 Mg
- Warning
- Description
- Clinical Pharmacology
- Indications And Usage
- Contraindications
- Warnings
- Precautions
- Adverse Reactions
- Overdosage
- Dosage And Administration
- How Supplied
- Important Medical Information Patient Card
- Warning:
- Description:
- Chemical Name:
- Structural Formula:
- Clinical Pharmacology:
- Indications And Usage:
- Contraindications:
- Warnings:
- Precautions:
- Adverse Reactions:
- Overdosage:
- Dosage And Administration:
- How Supplied:
- Disulfiram 250 Mg Container Label
- Disulfiram 500 Mg Container Label
- Warning:
- Chemical Name
- Structural Formula
- Package/label Principal Display Panel
- Indication And Usage:
- Disulfiram
No Title 1572552583 ⮝
5035
5036Rx only
WARNING
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.
No Title 1572450077 ⮝
5035
5036Rx only
WARNING
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.
Description ⮝
Disulfiram, USP is an alcohol antagonist drug.
CHEMICAL NAME
bis(diethylthiocarbamoyl) disulfide.
STRUCTURAL FORMULA
C10H20N2S4 M.W. 296.54
Disulfiram, USP occurs as a white to off-white, odorless, and almost tasteless powder, soluble in water to the extent of about 20 mg in 100 mL, and in alcohol to the extent of about 3.8 g in 100 mL.
Each tablet for oral administration contains 250 mg or 500 mg disulfiram, USP. Tablets also contain colloidal silicon dioxide, lactose anhydrous, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, and stearic acid.
Clinical Pharmacology ⮝
Disulfiram produces a sensitivity to alcohol which results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol.
Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism following disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone.
Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to hereinafter as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not appear to influence the rate of alcohol elimination from the body.
Disulfiram is absorbed slowly from the gastrointestinal tract and is eliminated slowly from the body. One (or even two) weeks after a patient has taken his last dose of disulfiram, ingestion of alcohol may produce unpleasant symptoms.
Prolonged administration of disulfiram does not produce tolerance; the longer a patient remains on therapy, the more exquisitely sensitive he becomes to alcohol.
Indications And Usage ⮝
Disulfiram Tablets USP are an aid in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage.
Disulfiram Tablets USP are not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.
Contraindications ⮝
Patients who are receiving or have recently received metronidazole, paraldehyde, alcohol, or alcohol-containing preparations, e.g., cough syrups, tonics and the like, should not be given disulfiram.
Disulfiram is contraindicated in the presence of severe myocardial disease or coronary occlusion, psychoses, and hypersensitivity to disulfiram or to other thiuram derivatives used in pesticides and rubber vulcanization.
Warnings ⮝
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.
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. He should also be warned that reactions may occur with alcohol up to 14 days after ingesting disulfiram.
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. In severe reactions there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.
The intensity of the reaction varies with each individual, but is generally proportional to the amounts of disulfiram and alcohol ingested. Mild reactions may occur in the sensitive individual when the blood alcohol concentration is increased to as little as 5 to 10 mg per 100 mL. Symptoms are fully developed at 50 mg per 100 mL, and unconsciousness usually results when the blood alcohol level reaches 125 to 150 mg.
The duration of the reaction varies from 30 to 60 minutes, to several hours in the more severe cases, or as long as there is alcohol in the blood.
Concomitant Conditions
Because of the possibility of an accidental disulfiram-alcohol reaction, disulfiram should be used with extreme caution in patients with any of the following conditions: diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or insufficiency.
Precautions ⮝
Patients with a history of rubber contact dermatitis should be evaluated for hypersensitivity to thiuram derivatives before receiving disulfiram (see CONTRAINDICATIONS).
Alcoholism may accompany or be followed by dependence on narcotics or sedatives. Barbiturates and disulfiram have been administered concurrently without untoward effects; the possibility of initiating a new abuse should be considered.
Hepatic toxicity including hepatic failure resulting in transplantation or death have been reported. Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many months of therapy. Hepatic toxicity has occurred in patients with or without prior history of abnormal liver function. Patients should be advised to immediately notify their physician of any early symptoms of hepatitis, such as fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, or dark urine.
Baseline and follow-up liver function tests (10 to 14 days) are suggested to detect any hepatic dysfunction that may result with disulfiram therapy. In addition, a complete blood count and serum chemistries, including liver function tests, should be monitored.
Patients taking disulfiram tablets should not be exposed to ethylene dibromide or its vapors. This precaution is based on preliminary results of animal research currently in progress that suggest a toxic interaction between inhaled ethylene dibromide and ingested disulfiram resulting in a higher incidence of tumors and mortality in rats. A correlation between this finding and humans, however, has not been demonstrated.
Drug Interactions
Disulfiram appears to decrease the rate at which certain drugs are metabolized and therefore may increase the blood levels and the possibility of clinical toxicity of drugs given concomitantly.
DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE PATIENTS RECEIVING PHENYTOIN AND ITS CONGENERS, SINCE THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS CAN LEAD TO PHENYTOIN INTOXICATION. PRIOR TO ADMINISTERING DISULFIRAM TO A PATIENT ON PHENYTOIN THERAPY, A BASELINE PHENYTOIN SERUM LEVEL SHOULD BE OBTAINED. SUBSEQUENT TO INITIATION OF DISULFIRAM THERAPY, SERUM LEVELS OF PHENYTOIN SHOULD BE DETERMINED ON DIFFERENT DAYS FOR EVIDENCE OF AN INCREASE OR FOR A CONTINUING RISE IN LEVELS. INCREASED PHENYTOIN LEVELS SHOULD BE TREATED WITH APPROPRIATE DOSAGE ADJUSTMENT.
It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram, since disulfiram may prolong prothrombin time.
Patients taking isoniazid when disulfiram is given should be observed for the appearance of unsteady gait or marked changes in mental status, the disulfiram should be discontinued if such signs appear.
In rats, simultaneous ingestion of disulfiram and nitrite in the diet for 78 weeks has been reported to cause tumors, and it has been suggested that disulfiram may react with nitrites in the rat stomach to form a nitrosamine, which is tumorigenic. Disulfiram alone in the rat s diet did not lead to such tumors. The relevance of this finding to humans is not known at this time.
Usage in Pregnancy
The safe use of this drug in pregnancy has not been established. Therefore, disulfiram should be used during pregnancy only when, in the judgement of the physician, the probable benefits outweigh the possible risks.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
Nursing Mothers
It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, disulfiram should not be given to nursing mothers.
Geriatric Use
A determination has not been made whether controlled clinical studies of disulfiram included sufficient numbers of subjects aged 65 and over to define a difference in response from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.
Adverse Reactions ⮝
See CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS.
OPTIC NEURITIS, PERIPHERAL NEURITIS, POLYNEURITIS, AND PERIPHERAL NEUROPATHY MAY OCCUR FOLLOWING ADMINISTRATION OF DISULFIRAM.
Multiple cases of hepatitis, including both cholestatic and fulminant hepatitis, as well as hepatic failure resulting in transplantation or death, have been reported with administration of disulfiram.
Occasional skin eruptions are, as a rule, readily controlled by concomitant administration of an antihistaminic drug.
In a small number of patients, a transient mild drowsiness, fatigability, impotence, headache, acneform eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may be experienced during the first two weeks of therapy. These complaints usually disappear spontaneously with the continuation of therapy, or with reduced dosage.
Psychotic reactions have been noted, attributable in most cases to high dosage, combined toxicity (with metronidazole or isoniazid), or to the unmasking of underlying psychoses in patients stressed by the withdrawal of alcohol.
Overdosage ⮝
No specific information is available on the treatment of overdosage with disulfiram. It is recommended that the physician contact the local Poison Control Center.
Dosage And Administration ⮝
Disulfiram tablets should never be administered until the patient has abstained from alcohol for at least 12 hours.
Initial Dosage Schedule
In the first phase of treatment, a maximum of 500 mg daily is given in a single dose for one to two weeks. Although usually taken in the morning, disulfiram tablets may be taken on retiring by patients who experience a sedative effect. Alternatively, to minimize, or eliminate, the sedative effect, dosage may be adjusted downward.
Maintenance Regimen
The average maintenance dose is 250 mg daily (range, 125 to 500 mg), it should not exceed 500 mg daily.
Note: Occasionally patients, while seemingly on adequate maintenance doses of disulfiram tablets, report that they are able to drink alcoholic beverages with impunity and without any symptomatology. All appearances to the contrary, such patients must be presumed to be disposing of their tablets in some manner without actually taking them. Until such patients have been observed reliably taking their daily disulfiram tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram tablets are ineffective.
Duration of Therapy
The daily, uninterrupted administration of disulfiram tablets must be continued until the patient is fully recovered socially and a basis for permanent self-control is established. Depending on the individual patient, maintenance therapy may be required for months or even years.
Trial with Alcohol
During early experience with disulfiram tablets, it was thought advisable for each patient to have at least one supervised alcohol-drug reaction. More recently, the test reaction has been largely abandoned. Furthermore, such a test reaction should never be administered to a patient over 50 years of age. A clear, detailed and convincing description of the reaction is felt to be sufficient in most cases.
However, where a test reaction is deemed necessary, the suggested procedure is as follows:
After the first one to two weeks therapy with 500 mg daily, a drink of 15 mL (1/2 oz) of 100 proof whiskey, or equivalent, is taken slowly. This test dose of alcoholic beverage may be repeated once only, so that the total dose does not exceed 30 mL (1 oz) of whiskey. Once a reaction develops, no more alcohol should be consumed. Such tests should be carried out only when the patient is hospitalized, or comparable supervision and facilities, including oxygen, are available.
Management of Disulfiram Tablets-Alcohol Reaction
In severe reactions, whether caused by an excessive test dose or by the patient s unsupervised ingestion of alcohol, supportive measures to restore blood pressure and treat shock should be instituted. Other recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), vitamin C intravenously in massive doses (1 g) and ephedrine sulfate. Antihistamines have also been used intravenously. Potassium levels should be monitored, particularly in patients on digitalis, since hypokalemia has been reported.
How Supplied ⮝
Disulfiram Tablets USP are available as follows:
250 mg - white, round, unscored, biconvex tablets, debossed with OP over 706 on one side and plain on the other side, in bottles of 100 tablets (NDC 0093-5035-01).
500 mg - white, round, scored tablets, debossed with OP over 707 on one side and scored on the other side, in bottles of 100 tablets (NDC 0093-5036-01).
Store at 20 to 25 C (68 to 77 F) [See USP Controlled Room Temperature].
Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required).
KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.
Manufactured In Croatia By:
PLIVA HRVATSKA d.o.o.
Zagreb, Croatia
Manufactured For:
TEVA PHARMACEUTICALS USA, INC.
North Wales, PA 19454
Rev. B 9/2015
Package/label Display Panel ⮝
Disulfiram Tablets USP 500 mg 100s Label Text
NDC 0093-5036-01
Disulfiram
Tablets USP
500 mgSee Side Panel for Warnings
Rx only
100 TABLETS
TEVA
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:0093-5035 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 250 mg
Inactive Ingredients Ingredient Name Strength SILICON DIOXIDE (UNII: ETJ7Z6XBU4) ANHYDROUS LACTOSE (UNII: 3SY5LH9PMK) MAGNESIUM STEARATE (UNII: 70097M6I30) MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2) STEARIC ACID (UNII: 4ELV7Z65AP)
Product Characteristics Color WHITE Score no score Shape ROUND Size 10mm Flavor Imprint Code OP;706 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:0093-5035-01 100 in 1 BOTTLE; Type 0: Not a Combination Product 04/15/2011
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA088482 04/15/2011
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:0093-5036 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 500 mg
Inactive Ingredients Ingredient Name Strength SILICON DIOXIDE (UNII: ETJ7Z6XBU4) ANHYDROUS LACTOSE (UNII: 3SY5LH9PMK) MAGNESIUM STEARATE (UNII: 70097M6I30) MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2) STEARIC ACID (UNII: 4ELV7Z65AP)
Product Characteristics Color WHITE Score 2 pieces Shape ROUND Size 13mm Flavor Imprint Code OP;707 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:0093-5036-01 100 in 1 BOTTLE; Type 0: Not a Combination Product 07/19/2011
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA088483 07/19/2011
Labeler - Teva Pharmaceuticals USA, Inc. (001627975) Revised: 9/2018 Document Id: 03847892-6961-4776-b673-04c901b0772e Set id: a49396ee-da77-42df-b94c-130d2fb3dfbc Version: 10 Effective Time: 20180910 Teva Pharmaceuticals USA, Inc.
⮝
WARNING:
Disulfiram tablets should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.
Principal Display Panel - 250 Mg ⮝
NDC 0378-4140-01
Disulfiram
Tablets, USP250 mg
WARNING: To The Pharmacist: When dis-
pensing this product, include the following
as part of the labeling:
WARNING: Administration of this drug
without the full knowledge of the patient
may result in serious complications.See side panel
for additional
Warnings.Rx only 100 Tablets
Each tablet contains: Disulfiram, USP 250 mg
WARNING: To The Physician: This is a potent drug;
indiscriminate use may result in serious undesirable re-
actions. Before administering this product, physicians
should familiarize themselves with the attached literature.Dispense in a tight, light-resistant
container as defined in the USP
using a child-resistant closure.Keep container tightly closed.
Keep this and all medication
out of the reach of children.Store at 20 to 25 C (68 to 77 F).
[See USP Controlled Room
Temperature.]Usual Dosage: See accompanying
prescribing information.Mylan Pharmaceuticals Inc.
Morgantown, WV 26505 U.S.A.RM4140A
Principal Display Panel - 500 Mg ⮝
NDC 0378-4141-01
Disulfiram
Tablets, USP500 mg
WARNING: To The Pharmacist: When dis-
pensing this product, include the following
as part of the labeling:
WARNING: Administration of this drug
without the full knowledge of the patient
may result in serious complications.See side panel
for additional
Warnings.Rx only 100 Tablets
Each tablet contains: Disulfiram, USP 500 mg
WARNING: To The Physician: This is a potent drug;
indiscriminate use may result in serious undesirable re-
actions. Before administering this product, physicians
should familiarize themselves with the attached literature.Dispense in a tight, light-resistant
container as defined in the USP
using a child-resistant closure.Keep container tightly closed.
Keep this and all medication
out of the reach of children.Store at 20 to 25 C (68 to 77 F).
[See USP Controlled Room
Temperature.]Usual Dosage: See accompanying
prescribing information.Mylan Pharmaceuticals Inc.
Morgantown, WV 26505 U.S.A.RM4141A
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:0378-4140 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 250 mg
Inactive Ingredients Ingredient Name Strength ANHYDROUS LACTOSE (UNII: 3SY5LH9PMK) SILICON DIOXIDE (UNII: ETJ7Z6XBU4) MAGNESIUM STEARATE (UNII: 70097M6I30) MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2) STEARIC ACID (UNII: 4ELV7Z65AP)
Product Characteristics Color WHITE (white to off-white) Score no score Shape ROUND Size 11mm Flavor Imprint Code M;DS;2 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:0378-4140-01 100 in 1 BOTTLE, PLASTIC; Type 0: Not a Combination Product 03/04/2015 11/30/2019
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA203916 03/04/2015 11/30/2019
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:0378-4141 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 500 mg
Inactive Ingredients Ingredient Name Strength ANHYDROUS LACTOSE (UNII: 3SY5LH9PMK) SILICON DIOXIDE (UNII: ETJ7Z6XBU4) MAGNESIUM STEARATE (UNII: 70097M6I30) MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2) STEARIC ACID (UNII: 4ELV7Z65AP)
Product Characteristics Color WHITE (white to off-white) Score 2 pieces Shape OVAL (modified capsule-shaped) Size 19mm Flavor Imprint Code MYLAN;DS;500 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:0378-4141-01 100 in 1 BOTTLE, PLASTIC; Type 0: Not a Combination Product 03/04/2015 11/30/2019
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA203916 03/04/2015 11/30/2019
Labeler - Mylan Pharmaceuticals Inc. (059295980) Revised: 9/2013 Document Id: a7324aaf-2fcf-4b14-9b16-788eb6c189c7 Set id: d2361d16-94fc-43a9-8009-ed03dce0544f Version: 6 Effective Time: 20130918 Mylan Pharmaceuticals Inc.
Warning ⮝
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.
Description ⮝
Disulfiram is an alcohol antagonist drug.
CHEMICAL NAME:
bis(diethylthiocarbamoyl) disulfide.
STRUCTURAL FORMULA:
Disulfiram occurs as a white to off-white, odorless, and almost tasteless powder, soluble in water to the extent of about 20 mg in 100 mL, and in alcohol to the extent of about 3.8 g in 100 mL.
Each tablet for oral administration contains 250 mg disulfiram, USP. Tablets also contain colloidal silicon dioxide, anhydrous lactose, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, and stearic acid.
Clinical Pharmacology ⮝
Disulfiram produces a sensitivity to alcohol which results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol.
Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism following disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone.
Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to hereinafter as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not appear to influence the rate of alcohol elimination from the body.
Disulfiram is absorbed slowly from the gastrointestinal tract and is eliminated slowly from the body. One (or even two) weeks after a patient has taken his last dose of disulfiram, ingestion of alcohol may produce unpleasant symptoms.
Prolonged administration of disulfiram does not produce tolerance; the longer a patient remains on therapy, the more exquisitely sensitive he becomes to alcohol.
Indications And Usage ⮝
Disulfiram is an aid in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage.
Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.
Contraindications ⮝
Patients who are receiving or have recently received metronidazole, paraldehyde, alcohol, or alcohol-containing preparations, e.g., cough syrups, tonics and the like, should not be given disulfiram.
Disulfiram is contraindicated in the presence of severe myocardial disease or coronary occlusion, psychoses, and hypersensitivity to disulfiram or to other thiuram derivatives used in pesticides and rubber vulcanization.
Warnings ⮝
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.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. He should also be warned that reactions may occur with alcohol up to 14 days after ingesting disulfiram.
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. In severe reactions there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.
The intensity of the reaction varies with each individual, but is generally proportional to the amounts of disulfiram and alcohol ingested. Mild reactions may occur in the sensitive individual when the blood alcohol concentration is increased to as little as 5 to 10 mg per 100 mL. Symptoms are fully developed at 50 mg per 100 mL, and unconsciousness usually results when the blood alcohol level reaches 125 to 150 mg.
The duration of the reaction varies from 30 to 60 minutes, to several hours in the more severe cases, or as long as there is alcohol in the blood.
Concomitant Conditions: Because of the possibility of an accidental disulfiram-alcohol reaction, disulfiram should be used with extreme caution in patients with any of the following conditions: diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or insufficiency.
Precautions ⮝
Patients with a history of rubber contact dermatitis should be evaluated for hypersensitivity to thiuram derivatives before receiving disulfiram (see CONTRAINDICATIONS).
It is suggested that every patient under treatment carry an Identification Card stating that he is receiving disulfiram and describing the symptoms most likely to occur as a result of the disulfiram-alcohol reaction. In addition, this card should indicate the physician or institution to be contacted in an emergency. (Cards may be obtained from Alvogen, Inc. upon request.)
Alcoholism may accompany or be followed by dependence on narcotics or sedatives. Barbiturates and disulfiram have been administered concurrently without untoward effects; the possibility of initiating a new abuse should be considered.
Hepatic toxicity including hepatic failure resulting in transplantation or death have been reported. Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many months of therapy. Hepatic toxicity has occurred in patients with or without prior history of abnormal liver function. Patients should be advised to immediately notify their physician of any early symptoms of hepatitis, such as fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, or dark urine.
Baseline and follow-up liver function tests (10-14 days) are suggested to detect any hepatic dysfunction that may result with disulfiram therapy. In addition, a complete blood count and serum chemistries, including liver function tests, should be monitored.
Patients taking disulfiram tablets should not be exposed to ethylene dibromide or its vapors. This precaution is based on preliminary results of animal research currently in progress that suggest a toxic interaction between inhaled ethylene dibromide and ingested disulfiram resulting in a higher incidence of tumors and mortality in rats. A correlation between this finding and humans, however, has not been demonstrated.
Drug Interactions
Disulfiram appears to decrease the rate at which certain drugs are metabolized and therefore may increase the blood levels and the possibility of clinical toxicity of drugs given concomitantly.
DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE PATIENTS RECEIVING PHENYTOIN AND ITS CONGENERS, SINCE THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS CAN LEAD TO PHENYTOIN INTOXICATION. PRIOR TO ADMINISTERING DISULFIRAM TO A PATIENT ON PHENYTOIN THERAPY, A BASELINE PHENYTOIN SERUM LEVEL SHOULD BE OBTAINED. SUBSEQUENT TO INITIATION OF DISULFIRAM THERAPY, SERUM LEVELS OF PHENYTOIN SHOULD BE DETERMINED ON DIFFERENT DAYS FOR EVIDENCE OF AN INCREASE OR FOR A CONTINUING RISE IN LEVELS. INCREASED PHENYTOIN LEVELS SHOULD BE TREATED WITH APPROPRIATE DOSAGE ADJUSTMENT.
It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram, since disulfiram may prolong prothrombin time.
Patients taking isoniazid when disulfiram is given should be observed for the appearance of unsteady gait or marked changes in mental status, the disulfiram should be discontinued if such signs appear.
In rats, simultaneous ingestion of disulfiram and nitrite in the diet for 78 weeks has been reported to cause tumors, and it has been suggested that disulfiram may react with nitrites in the rat stomach to form a nitrosamine, which is tumorigenic. Disulfiram alone in the rat's diet did not lead to such tumors. The relevance of this finding to humans is not known at this time.
Usage In Pregnancy
The safe use of this drug in pregnancy has not been established. Therefore, disulfiram should be used during pregnancy only when, in the judgement of the physician, the probable benefits outweigh the possible risks.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
Nursing Mothers
It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, disulfiram should not be given to nursing mothers.
Geriatric Use
A determination has not been made whether controlled clinical studies of disulfiram included sufficient numbers of subjects aged 65 and over to define a difference in response from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.
Adverse Reactions ⮝
(See CONTRAINDICATIONS , WARNINGS , and PRECAUTIONS.)
OPTIC NEURITIS, PERIPHERAL NEURITIS, POLYNEURITIS, AND PERIPHERAL NEUROPATHY MAY OCCUR FOLLOWING ADMINISTRATION OF DISULFIRAM.
Multiple cases of hepatitis, including both cholestatic and fulminant hepatitis, as well as hepatic failure resulting in transplantation or death, have been reported with administration of disulfiram.
Occasional skin eruptions are, as a rule, readily controlled by concomitant administration of an antihistaminic drug.
In a small number of patients, a transient mild drowsiness, fatigability, impotence, headache, acneform eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may be experienced during the first two weeks of therapy. These complaints usually disappear spontaneously with the continuation of therapy, or with reduced dosage.
Psychotic reactions have been noted, attributable in most cases to high dosage, combined toxicity (with metronidazole or isoniazid), or to the unmasking of underlying psychoses in patients stressed by the withdrawal of alcohol.
Overdosage ⮝
No specific information is available on the treatment of overdosage with disulfiram. It is recommended that the physician contact the local Poison Control Center.
Dosage And Administration ⮝
Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours.
Initial Dosage Schedule: In the first phase of treatment, a maximum of 500 mg daily is given in a single dose for one to two weeks. Although usually taken in the morning, disulfiram may be taken on retiring by patients who experience a sedative effect. Alternatively, to minimize, or eliminate, the sedative effect, dosage may be adjusted downward.
Maintenance Regimen: The average maintenance dose is 250 mg daily (range, 125 to 500 mg), it should not exceed 500 mg daily.
Note: Occasionally patients, while seemingly on adequate maintenance doses of disulfiram, report that they are able to drink alcoholic beverages with impunity and without any symptomatology. All appearances to the contrary, such patients must be presumed to be disposing of their tablets in some manner without actually taking them. Until such patients have been observed reliably taking their daily disulfiram tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram is ineffective.
Duration of Therapy: The daily, uninterrupted administration of disulfiram must be continued until the patient is fully recovered socially and a basis for permanent self-control is established. Depending on the individual patient, maintenance therapy may be required for months or even years.
Trial with Alcohol: During early experience with disulfiram, it was thought advisable for each patient to have at least one supervised alcohol-drug reaction. More recently, the test reaction has been largely abandoned. Furthermore, such a test reaction should never be administered to a patient over 50 years of age. A clear, detailed and convincing description of the reaction is felt to be sufficient in most cases.
However, where a test reaction is deemed necessary, the suggested procedure is as follows:
After the first one to two weeks' therapy with 500 mg daily, a drink of 15 mL (1/2 oz) of 100 proof whiskey, or equivalent, is taken slowly. This test dose of alcoholic beverage may be repeated once only, so that the total dose does not exceed 30 mL (1 oz) of whiskey. Once a reaction develops, no more alcohol should be consumed. Such tests should be carried out only when the patient is hospitalized, or comparable supervision and facilities, including oxygen, are available.Management of Disulfiram-Alcohol Reaction: In severe reactions, whether caused by an excessive test dose or by the patient's unsupervised ingestion of alcohol, supportive measures to restore blood pressure and treat shock should be instituted. Other recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), vitamin C intravenously in massive doses (1 g) and ephedrine sulfate. Antihistamines have also been used intravenously. Potassium levels should be monitored, particularly in patients on digitalis, since hypokalemia has been reported.
How Supplied ⮝
Disulfiram Tablets, USP are white, round, unscored tablets debossed 607.
Bottle of 30 NDC 47781-607-30
Dispense in a tight, light-resistant container as defined in the USP.
Store at 20 -25 C (68 -77 F). [See USP Controlled Room Temperature].
Manufactured by:
Norwich Pharmaceuticals, Inc.
Norwich, NY 13815 USADistributed by:
Alvogen, Inc.
Pine Brook, NJ 07058 USAPI607-02
Rev. 12/2017
PKG02361NDC 47781-607-30
DISULFIRAM TABLETS, USP
250 mgWARNING: To the Physician: This is a potent drug; indiscriminate use may result in serious undesirable reactions.
Before administering this product, physicians should familiarize themselves with the enclosed literature.To the Pharmacist: When dispensing this product, include the following as part of the Rx labeling:
WARNING: Administration of this drug without the full knowledge of the patient may result in serious complications.30 Tablets
Rx only
Important Medical Information Patient Card ⮝
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:47781-607 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 250 mg
Inactive Ingredients Ingredient Name Strength ANHYDROUS LACTOSE (UNII: 3SY5LH9PMK) MAGNESIUM STEARATE (UNII: 70097M6I30) SILICON DIOXIDE (UNII: ETJ7Z6XBU4) MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2) STEARIC ACID (UNII: 4ELV7Z65AP)
Product Characteristics Color white Score no score Shape ROUND Size 13mm Flavor Imprint Code 607 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:47781-607-01 100 in 1 BOTTLE; Type 0: Not a Combination Product 08/09/2013 12/31/2017 2 NDC:47781-607-30 30 in 1 BOTTLE, PLASTIC; Type 0: Not a Combination Product 08/09/2013
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA091681 08/09/2013
Labeler - Alvogen Inc. (008057330)
Establishment Name Address ID/FEI Business Operations Norwich Pharmaceuticals Inc. 132218731 ANALYSIS(47781-607) , MANUFACTURE(47781-607) , pack(47781-607) Revised: 9/2019 Document Id: fe1d47fe-06d8-d389-3697-058fa2c04877 Set id: b90f8ff4-4fb3-46ab-8149-cb55f24a4044 Version: 8 Effective Time: 20190912 Alvogen Inc.
Warning: ⮝
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge. The physician should instruct relatives accordingly.
Description: ⮝
Disulfiram is an alcohol antagonist drug.
Chemical Name: ⮝
bis(diethylthiocarbamoyl) disulfide.
Structural Formula: ⮝
Disulfiram occurs as a white to off-white, odorless, and almost tasteless powder, soluble in water to the extent of about 20 mg in 100 mL, and in alcohol to the extent of about 3.8 g in 100 mL.
Each tablet for oral administration contains 250 mg or 500 mg disulfiram, USP. Tablets also contain crospovidone, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone and silicon dioxide.
Clinical Pharmacology: ⮝
Disulfiram produces a sensitivity to alcohol which results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol.
Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism following disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone.
Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to hereinafter as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not appear to influence the rate of alcohol elimination from the body.
Disulfiram is absorbed slowly from the gastrointestinal tract and is eliminated slowly from the body. One (or even two) weeks after a patient has taken his last dose of disulfiram, ingestion of alcohol may produce unpleasant symptoms.
Prolonged administration of disulfiram does not produce tolerance; the longer a patient remains on therapy, the more exquisitely sensitive he becomes to alcohol.
Indications And Usage: ⮝
Disulfiram is an aid in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage.
Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.
Contraindications: ⮝
Patients who are receiving or have recently received metronidazole, paraldehyde, alcohol, or alcohol-containing preparations, e.g., cough syrups, tonics and the like, should not be given disulfiram.
Disulfiram is contraindicated in the presence of severe myocardial disease or coronary occlusion, psychoses, and hypersensitivity to disulfiram or to other thiuram derivatives used in pesticides and rubber vulcanization.
Warnings: ⮝
Disulfiram should be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge. The physician should instruct relatives accordingly. never
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. He should also be warned that reactions may occur with alcohol up to 14 days after ingesting disulfiram.
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. In severe reactions there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.
The intensity of the reaction varies with each individual, but is generally proportional to the amounts of disulfiram and alcohol ingested. Mild reactions may occur in the sensitive individual when the blood alcohol concentration is increased to as little as 5 to 10 mg per 100 mL. Symptoms are fully developed at 50 mg per 100 mL, and unconsciousness usually results when the blood alcohol level reaches 125 to 150 mg.
The duration of the reaction varies from 30 to 60 minutes, to several hours in the more severe cases, or as long as there is alcohol in the blood.
Concomitant Conditions:
Because of the possibility of an accidental disulfiram-alcohol reaction, disulfiram should be used with extreme caution in patients with any of the following conditions: diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or insufficiency.
Precautions: ⮝
Patients with a history of rubber contact dermatitis should be evaluated for hypersensitivity to thiuram derivatives before receiving disulfiram (see . CONTRAINDICATIONS)
It is suggested that every patient under treatment carry an Identification Card stating that he is receiving disulfiram and describing the symptoms most likely to occur as a result of the disulfiram-alcohol reaction. In addition, this card should indicate the physician or institution to be contacted in an emergency. (Cards may be obtained from Sigmapharm Laboratories, LLC. upon request.)
Alcoholism may accompany or be followed by dependence on narcotics or sedatives. Barbiturates and disulfiram have been administered concurrently without untoward effects; the possibility of initiating a new abuse should be considered.
Hepatic toxicity including hepatic failure resulting in transplantation or death have been reported. Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many months of therapy. Hepatic toxicity has occurred in patients with or without prior history of abnormal liver function. Patients should be advised to immediately notify their physician of any early symptoms of hepatitis, such as fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, or dark urine.
Baseline and follow-up liver function tests (10-14 days) are suggested to detect any hepatic dysfunction that may result with disulfiram therapy. In addition, a complete blood count and serum chemistries, including liver function tests, should be monitored.
Patients taking disulfiram tablets should not be exposed to ethylene dibromide or its vapors. This precaution is based on preliminary results of animal research currently in progress that suggest a toxic interaction between inhaled ethylene dibromide and ingested disulfiram resulting in a higher incidence of tumors and mortality in rats. A correlation between this finding and humans, however, has not been demonstrated.
Drug Interactions:
Disulfiram appears to decrease the rate at which certain drugs are metabolized and therefore may increase the blood levels and the possibility of clinical toxicity of drugs given concomitantly.
DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE PATIENTS RECEIVING PHENYTOIN AND ITS CONGENERS, SINCE THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS CAN LEAD TO PHENYTOIN INTOXICATION. PRIOR TO ADMINISTERING DISULFIRAM TO A PATIENT ON PHENYTOIN THERAPY, A BASELINE PHENYTOIN SERUM LEVEL SHOULD BE OBTAINED. SUBSEQUENT TO INITIATION OF DISULFIRAM THERAPY, SERUM LEVELS OF PHENYTOIN SHOULD BE DETERMINED ON DIFFERENT DAYS FOR EVIDENCE OF AN INCREASE OR FOR A CONTINUING RISE IN LEVELS. INCREASED PHENYTOIN LEVELS SHOULD BE TREATED WITH APPROPRIATE DOSAGE ADJUSTMENT.
It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram, since disulfiram may prolong prothrombin time.
Patients taking isoniazid when disulfiram is given should be observed for the appearance of unsteady gait or marked changes in mental status, the disulfiram should be discontinued if such signs appear.
In rats, simultaneous ingestion of disulfiram and nitrite in the diet for 78 weeks has been reported to cause tumors, and it has been suggested that disulfiram may react with nitrites in the rat stomach to form a nitrosamine, which is tumorigenic. Disulfiram alone in the rat s diet did not lead to such tumors. The relevance of this finding to humans is not known at this time.
Usage in Pregnancy:
The safe use of this drug in pregnancy has not been established. Therefore, disulfiram should be used during pregnancy only when, in the judgment of the physician, the probable benefits outweigh the possible risks.
Pediatric Use:
Safety and effectiveness in pediatric patients have not been established.
Nursing Mothers:
It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, disulfiram should not be given to nursing mothers.
Geriatric Use:
A determination has not been made whether controlled clinical studies of disulfiram included sufficient numbers of subjects aged 65 and over to define a difference in response from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.
Adverse Reactions: ⮝
(See , AND .) CONTRAINDICATIONSWARNINGSPRECAUTIONS
OPTIC NEURITIS, PERIPHERAL NEURITIS, POLYNEURITIS, AND PERIPHERAL NEUROPATHY MAY OCCUR FOLLOWING ADMINISTRATION OF DISULFIRAM.
Multiple cases of hepatitis, including both cholestatic and fulminant hepatitis, as well as hepatic failure resulting in transplantation or death, have been reported with administration of disulfiram.
Occasional skin eruptions are, as a rule, readily controlled by concomitant administration of an antihistaminic drug.
In a small number of patients, a transient mild drowsiness, fatigability, impotence, headache, acneform eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste may be experienced during the first two weeks of therapy. These complaints usually disappear spontaneously with the continuation of therapy, or with reduced dosage.
Psychotic reactions have been noted, attributable in most cases to high dosage, combined toxicity (with metronidazole or isoniazid), or to the unmasking of underlying psychoses in patients stressed by the withdrawal of alcohol.
Overdosage: ⮝
No specific information is available on the treatment of overdosage with disulfiram. It is recommended that the physician contact the local Poison Control Center.
Dosage And Administration: ⮝
Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours.
Initial Dosage Schedule:
In the first phase of treatment, a of 500 mg daily is given in a single dose for one to two weeks. Although usually taken in the morning, disulfiram may be taken on retiring by patients who experience a sedative effect. Alternatively, to minimize, or eliminate, the sedative effect, dosage may be adjusted downward. maximum
Maintenance Regimen:
The average maintenance dose is 250 mg daily (range, 125 to 500 mg), it should not exceed 500 mg daily.
Occasionally patients, while seemingly on adequate maintenance doses of disulfiram, report that they are able to drink alcoholic beverages with impunity and without any symptomatology. All appearances to the contrary, such patients must be presumed to be disposing of their tablets in some manner without actually taking them. Until such patients have been observed reliably taking their daily disulfiram tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram is ineffective. Note:
Duration of Therapy:
The daily, uninterrupted administration of disulfiram must be continued until the patient is fully recovered socially and a basis for permanent self-control is established. Depending on the individual patient, maintenance therapy may be required for months or even years.
Trial with Alcohol:
During early experience with disulfiram, it was thought advisable for each patient to have at least one supervised alcohol-drug reaction. More recently, the test reaction has been largely abandoned. Furthermore, such a test reaction should never be administered to a patient over 50 years of age. A clear, detailed and convincing description of the reaction is felt to be sufficient in most cases.
However, where a test reaction is deemed necessary, the suggested procedure is as follows:
After the first one to two weeks therapy with 500 mg daily, a drink of 15 mL (1/2 oz) of 100 proof whiskey, or equivalent, is taken slowly. This test dose of alcoholic beverage may be repeated once only, so that the total dose does not exceed 30 mL (1 oz) of whiskey. Once a reaction develops, no more alcohol should be consumed. Such tests should be carried out only when the patient is hospitalized, or comparable supervision and facilities, including oxygen, are available.
Management of Disulfiram-Alcohol Reaction:
In severe reactions, whether caused by an excessive test dose or by the patient s unsupervised ingestion of alcohol, supportive measures to restore blood pressure and treat shock should be instituted. Other recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), vitamin C intravenously in massive doses (1 g) and ephedrine sulfate. Antihistamines have also been used intravenously. Potassium levels should be monitored, particularly in patients on digitalis, since hypokalemia has been reported.
How Supplied: ⮝
Disulfiram Tablets, USP:
250 mg - White, capsule shaped tablets debossed 28 on one side and plain on the other side. They are available in bottles of 100 s (NDC 64980-171-01).
500 mg - White, capsule shaped bisected tablets debossed with and 29 on either side of the bisection and plain on the other side. They are available in bottles of 100 s (NDC 64980-172-01).
Dispense in a tight, light-resistant container as defined in the USP. Store at 20 to 25 C (68 to 77 F). [See USP Controlled Room Temperature].
Manufactured for: Rising Pharmaceuticals, Inc. 3 Pearl Court Allendale, NJ 07401
Manufactured by: Sigmapharm Laboratories, LLC Bensalem, PA 19020
OS029-03 REV.0211
Disulfiram 250 Mg Container Label ⮝
Rising
NDC 64980-171-03
Disulfiram Tablets, USP
250 mg
PHARMACIST: DISPENSE IN THE ORIGINAL CONTAINER. SEE SIDE PANEL FOR WARNINGS.
30 Tablets
Rx Only
Disulfiram 500 Mg Container Label ⮝
Rising
NDC 64980-172-03
Disulfiram Tablets, USP
500 mg
PHARMACIST: DISPENSE IN THE ORIGINAL CONTAINER. SEE SIDE PANEL FOR WARNINGS.
30 Tablets
Rx Only
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:64980-171 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 250 mg
Inactive Ingredients Ingredient Name Strength CROSPOVIDONE (UNII: 2S7830E561) LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X) MAGNESIUM STEARATE (UNII: 70097M6I30) CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U) POVIDONE (UNII: FZ989GH94E) SILICON DIOXIDE (UNII: ETJ7Z6XBU4)
Product Characteristics Color WHITE (white to off-white) Score no score Shape CAPSULE Size 14mm Flavor Imprint Code 28 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:64980-171-03 30 in 1 BOTTLE; Type 0: Not a Combination Product 08/02/2016 2 NDC:64980-171-01 100 in 1 BOTTLE; Type 0: Not a Combination Product 04/08/2011 04/30/2019
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA091619 04/08/2011
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:64980-172 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 500 mg
Inactive Ingredients Ingredient Name Strength CROSPOVIDONE (UNII: 2S7830E561) LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X) MAGNESIUM STEARATE (UNII: 70097M6I30) CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U) POVIDONE (UNII: FZ989GH94E) SILICON DIOXIDE (UNII: ETJ7Z6XBU4)
Product Characteristics Color WHITE (white to off-white) Score 2 pieces Shape CAPSULE Size 19mm Flavor Imprint Code 29 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:64980-172-03 30 in 1 BOTTLE; Type 0: Not a Combination Product 08/02/2016 2 NDC:64980-172-01 100 in 1 BOTTLE; Type 0: Not a Combination Product 04/08/2011 11/30/2018
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA091619 04/08/2011
Labeler - Rising Pharmaceuticals, Inc. (041241766)
Registrant - Sigmapharm Laboratories, LLC (556234636)
Establishment Name Address ID/FEI Business Operations Sigmapharm Laboratories, LLC 556234636 manufacture(64980-171, 64980-172) , analysis(64980-171, 64980-172) Revised: 8/2016 Document Id: 9bd05731-ba84-41f4-baca-ad5d1feebe0f Set id: 7b1531be-7282-4577-89f6-67275ef19978 Version: 5 Effective Time: 20160810 Rising Pharmaceuticals, Inc.
Warning: ⮝
Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge.
The physician should instruct relatives accordingly.
Chemical Name ⮝
bis(diethylthiocarbamoyl) disulfide.
Structural Formula ⮝
C10H20N2S4 M.W. 296.54
Disulfiram USP occurs as a white to off-white, odorless powder, soluble in water to the extent of about 20 mg in 100 mL, and in alcohol to the extent of about 3.8 g in 100 mL.
Each tablet for oral administration contains 250 mg or 500 mg disulfiram USP and the following inactive ingredients: colloidal silicon dioxide, magnesium stearate, silicified microcrystalline cellulose and sodium starch glycolate.
Package/label Principal Display Panel ⮝
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:0054-0356 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 250 mg
Inactive Ingredients Ingredient Name Strength SILICON DIOXIDE (UNII: ETJ7Z6XBU4) MAGNESIUM STEARATE (UNII: 70097M6I30) CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2)
Product Characteristics Color WHITE Score no score Shape ROUND Size 10mm Flavor Imprint Code 54734 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:0054-0356-25 100 in 1 BOTTLE; Type 0: Not a Combination Product 11/04/2014 2 NDC:0054-0356-13 30 in 1 BOTTLE; Type 0: Not a Combination Product 11/04/2014
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA202652 11/04/2014
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:0054-0357 Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 500 mg
Inactive Ingredients Ingredient Name Strength SILICON DIOXIDE (UNII: ETJ7Z6XBU4) MAGNESIUM STEARATE (UNII: 70097M6I30) CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U) SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2)
Product Characteristics Color WHITE Score 2 pieces Shape OVAL Size 19mm Flavor Imprint Code 54544 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:0054-0357-25 100 in 1 BOTTLE; Type 0: Not a Combination Product 11/04/2014 2 NDC:0054-0357-13 30 in 1 BOTTLE; Type 0: Not a Combination Product 11/04/2014
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA202652 11/04/2014
Labeler - West-Ward Pharmaceuticals Corp. (080189610)
Establishment Name Address ID/FEI Business Operations West-Ward Columbus Inc. 058839929 MANUFACTURE(0054-0356, 0054-0357) Revised: 7/2016 Document Id: e81b6a85-8301-4d15-b54b-875756ed3016 Set id: 719b12b2-061b-4893-b888-34191e45bc57 Version: 2 Effective Time: 20160706 West-Ward Pharmaceuticals Corp.
Indication And Usage: ⮝
Disulfiram is an aid in the management of selected chronic alcohol patients who to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage. want
Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.
Disulfiram ⮝
DISULFIRAM
disulfiram tablet
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:68151-2694(NDC:64980-171) Route of Administration ORAL
Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength DISULFIRAM (UNII: TR3MLJ1UAI) (DISULFIRAM - UNII:TR3MLJ1UAI) DISULFIRAM 250 mg
Inactive Ingredients Ingredient Name Strength CROSPOVIDONE (UNII: 68401960MK) LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X) MAGNESIUM STEARATE (UNII: 70097M6I30) CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U) POVIDONES (UNII: FZ989GH94E) SILICON DIOXIDE (UNII: ETJ7Z6XBU4)
Product Characteristics Color WHITE (white to off-white) Score no score Shape CAPSULE Size 14mm Flavor Imprint Code 28 Contains
Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:68151-2694-0 1 in 1 PACKAGE
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA091619 04/01/2011
Labeler - Carilion Materials Management (079239644)
Registrant - Carilion Materials Management (079239644)
Establishment Name Address ID/FEI Business Operations Carilion Materials Management 079239644 REPACK(68151-2694) Revised: 12/2013 Document Id: d132ab2a-1616-4984-b277-e685a5fc0e1f Set id: 35f34124-7300-4b96-911f-d9f03016ea14 Version: 2 Effective Time: 20131230 Carilion Materials Management
