Disulfiram


  Issues for Surgery


Risk of alcohol relapse if omitted.


Risk of disulfiram-alcohol reaction with concomitant ethanol / alcohol exposure if continued (see Further Information).


  Advice in the Perioperative period


Elective and Emergency Surgery

Continue.


Post-operative Advice

Restart post-operatively as soon as next dose is due.

Check excipients of any newly started preparations as even trace amounts of ethanol / alcohol should be avoided (see Further Information).


  Interaction(s) with Common Anaesthetic Agents


Ethanol / Alcohol containing preparations

Disulfiram-alcohol reaction can be precipitated by exposure to ethanol / alcohol, even in small quantities found in topical preparations, which potentially can be life-threatening (see Further Information)1, 2, 3. Check excipients of any products used in theatre.


Benzodiazepines

Disulfiram inhibits the metabolism of some benzodiazepines e.g. diazepam, causing increased plasma concentration and therefore increased sedation2, 3. The clinical significance of this interaction is unknown but bear in mind in the case of an unexpected response to treatment3.


  Interaction(s) with other Common Medicines used in the Perioperative Period

 

Metronidazole

Disulfiram increases the risk of acute psychoses when given with metronidazole1, 2, 3 and can also increase the risk of peripheral neuropathy1 – avoid concomitant treatment3.


Alcohol containing preparations

Disulfiram-alcohol reaction can be precipitated by exposure to alcohol, even in small quantities found in topical preparations, which can be life-threatening1, 2, 3 (see Further Information). Check excipients of any newly prescribed preparations, particularly if swallowing difficulties post-operatively necessitate the use of liquid preparations.


  Further Information


Disulfiram-alcohol reaction

Disulfiram irreversibly inhibits acetaldehyde dehydrogenase; therefore, ingestion of ethanol leads to accumulation of acetaldehyde. Reactions begin within 15 minutes of ethanol exposure and can last for a few hours. Symptoms may be severe and life-threatening and include vasodilation, facial flushing, pyrexia, sweating, nausea, vomiting, urticaria, anxiety, dizziness, headache, blurred vision, dyspnoea, palpitations, hyperventilation, tachycardia, hypotension, respiratory depression, chest pain, QT-interval prolongation, convulsions and coma2. Alcohol, including small amounts in toiletries, medicinal products, food products and topical preparations3 should be avoided for 14 days after discontinuing treatment1.


  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 28th June 2021]
  2. Summary of Product Characteristics – Disulfiram 200mg tablets. Brown & Burk UK Ltd. Accessed via www.medicines.org.uk 28/06/2021 [date of revision of the text March 2020]
  3. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 28th June 2021]