Contraindications Receiving opioid Receiving opioid agonists Hypersensitivity Severe cardiovascular, agonists respiratory, or renal Physiologic opioid Severe renal disease Physiologic opioid dependence with use impairment (CrCl ≤ dependence with within past 7 days 30 ml/min) Severe hepatic use within past 7 dysfunction (i.e., Acute opioid withdrawal days transaminase levels Failed naloxone > 5 times upper limit of Acute opioid challenge test normal or abnormal withdrawal Positive urine opioid bilirubin) Failed naloxone screen Severe psychiatric challenge test hepatitis or liver disorders, especially Positive urine opioid failure psychotic and screen Hypersensitivity cognitive disorders Acute hepatitis or liver Inadequate muscle mass and suicidal ideation failure Gluteal adiposity that Poor impulse control Hypersensitivity precludes deep Metronidazole or intramuscular injection ketoconazole, which already induce similar reaction to alcohol Hypersensitivity to disulfiram or thiuram derivatives Warnings / Active liver disease Active liver disease Monitor for emergence Never administer to a Precautions of depression or patient who is alcohol Severe renal failure Moderate to severe renal suicidality intoxicated; educate insufficiency (no data) Pregnancy category C patient and family Reduce dose in Injection site reactions about risks patients with Use intramuscular impairment, Disulfiram-alcohol injections with caution including elderly reactions can occur in patients with even with small Pregnancy category C thrombocytopenia or amounts of alcohol; coagulation disorders severe reactions may Pregnancy category C be fatal Use with extreme caution in patients at high risk from disulfiram-alcohol reactions, including those with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or insufficiency Hepatic toxicity and failure Exposure to ethylene dibromide in rats has increased the risk of tumors and mortality Hypersensitivity reactions: history of rubber contact dermatitis should be evaluated for thiuram allergy (contraindication) Pregnancy category C
Contraindications Receiving opioid agonists Physiologic opioid dependence with use within past 7 days Acute opioid withdrawal Failed naloxone challenge test Positive urine opioid screen Acute hepatitis or liver failure Hypersensitivity Receiving opioid agonists Physiologic opioid dependence with use within past 7 days Acute opioid withdrawal Failed naloxone challenge test Positive urine opioid screen hepatitis or liver failure Hypersensitivity Inadequate muscle mass Gluteal adiposity that precludes deep intramuscular injection Hypersensitivity Severe renal impairment (CrCl ≤ 30 ml/min) Severe cardiovascular, respiratory, or renal disease Severe hepatic dysfunction (i.e., transaminase levels > 5 times upper limit of normal or abnormal bilirubin) Severe psychiatric disorders, especially psychotic and cognitive disorders and suicidal ideation Poor impulse control Metronidazole or ketoconazole, which already induce similar reaction to alcohol Hypersensitivity to disulfiram or thiuram derivatives Warnings / Precautions Active liver disease Severe renal failure Pregnancy category C Active liver disease Moderate to severe renal insufficiency (no data) Injection site reactions Use intramuscular injections with caution in patients with thrombocytopenia or coagulation disorders Pregnancy category C Monitor for emergence of depression or suicidality Reduce dose in patients with impairment, including elderly Pregnancy category C Never administer to a patient who is alcohol intoxicated; educate patient and family about risks Disulfiram-alcohol reactions can occur even with small amounts of alcohol; severe reactions may be fatal Use with extreme caution in patients at high risk from disulfiram-alcohol reactions, including those with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or insufficiency Hepatic toxicity and failure Exposure to ethylene dibromide in rats has increased the risk of tumors and mortality Hypersensitivity reactions: history of rubber contact dermatitis should be evaluated for thiuram allergy (contraindication) Pregnancy category C