Amitriptyline
Adverse Effect: Increased risk of a psychotic and confusional mental state Clinical Management: Monitor the patient for evidence of deteriorating mental status.
Chlordiazepoxide
Adverse Effect: An increased risk of chlordiazepoxide toxicity (CNS depression) Clinical Management: Monitor for signs of Chlordiazepoxide intoxication (e.g., sedation, dizziness, ataxia, weakness, decreased cognition or motor performance). If symptoms are present, reduce chlordiazepoxide dose or consider switching to a benzodiazepine eliminated by glucuronidation (e.g., lorazepam, oxazepam).
Diazepam
Adverse Effect: an increased risk of central nervous system depression Clinical Management: Monitor for signs of Diazepam intoxication (eg, sedation, dizziness, ataxia, weakness, decreased cognition or motor performance).
INH
Adverse Effect: changes in behavior, coordination
Clinical Management: Monitor patients for coordination difficulties and mood or behavioral changes. Consider dose reduction or discontinuation of disulfiram.
Imipramine
Adverse Effect: Increased bioavailability of imipramine Clinical Management: Monitor the patient for excessive adverse effects to imipramine.
Metronidazole
Adverse Effect: CNS toxicity (psychotic symptoms, confusion) Clinical Management: Disulfiram is contraindicated in patients who are receiving or have recently received metronidazole. Metronidazole should not be given to a patient who has received disulfiram within the last 14 days.
Naltrexone
Adverse Effect: Safety and efficacy of concomitant use of these drugs are not known Clinical Management: Avoid the concomitant use if possible, as both these medications are potentially hepatotoxic.
Omeprazole
Adverse Effect: disulfiram toxicity (confusion, disorientation, psychotic changes) Clinical Management: Closely monitor patient response with special attention to mental status changes when coadministering disulfiram and omeprazole. Dose reductions in either or both agents may be needed.
Phenytoin
Adverse Effect: an increased risk of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremors) Clinical Management: Monitor serum phenytoin concentrations with concomitant disulfiram therapy, as well as counseling patients to report any signs of phenytoin toxicity such as drowsiness, ataxia, and nystagmus. Decreased phenytoin dosage is often required with concomitant therapy.
Theophylline
Adverse Effect: Theophylline toxicity (nausea, vomiting, palpitations, seizures) Clinical Management: Theophylline serum concentrations should be closely monitored when disulfiram is added, discontinued, or when dosing changes occur. Dosing adjustments of theophylline may be necessary.
Warfarin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with disulfiram, and should be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation. |