disulfiram (Rx)

• carbamazepine carbamazepine, disulfiram. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.
• ethanol disulfiram will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug.

Monitor Closely (30)

• alprazolam disulfiram increases levels of alprazolam by decreasing metabolism. Use Caution/Monitor.
• atogepant disulfiram will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• avapritinib disulfiram will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• axitinib disulfiram increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• brexpiprazole disulfiram will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
• cholic acid disulfiram increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.
• clonazepam disulfiram increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.
• clorazepate disulfiram increases levels of clorazepate by decreasing metabolism. Use Caution/Monitor.
• cocaine topical disulfiram increases levels of cocaine topical by unknown mechanism. Use Caution/Monitor.
• diazepam disulfiram increases levels of diazepam by decreasing metabolism. Use Caution/Monitor.
• ethotoin disulfiram will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
• etravirine disulfiram will increase the level or effect of etravirine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
• finerenone disulfiram will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
• flibanserin disulfiram will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
• fosphenytoin disulfiram will increase the level or effect of fosphenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
• green tea disulfiram increases levels of green tea by decreasing elimination. Use Caution/Monitor. Combination may increase caffeine levels. Caution should be taken due to increased risk of adverse effects due to caffeine in green tea.
• isavuconazonium sulfate disulfiram will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• isoniazid disulfiram will increase the level or effect of isoniazid by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.

Minor (31)

• acetaminophen disulfiram will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• acetaminophen IV disulfiram will increase the level or effect of acetaminophen IV by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• acetaminophen rectal disulfiram will increase the level or effect of acetaminophen rectal by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• alosetron disulfiram will increase the level or effect of alosetron by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• bosentan disulfiram will increase the level or effect of bosentan by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• celecoxib disulfiram will increase the level or effect of celecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• chlordiazepoxide disulfiram increases levels of chlordiazepoxide by decreasing metabolism. Minor/Significance Unknown.
• dapsone disulfiram will increase the level or effect of dapsone by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• diclofenac disulfiram will increase the level or effect of diclofenac by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• ethotoin disulfiram increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.
• flurbiprofen disulfiram will increase the level or effect of flurbiprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• fluvastatin disulfiram will increase the level or effect of fluvastatin by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• fosphenytoin disulfiram increases levels of fosphenytoin by decreasing metabolism. Minor/Significance Unknown.
• ibuprofen disulfiram will increase the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• ibuprofen IV disulfiram will increase the level or effect of ibuprofen IV by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• isocarboxazid disulfiram, isocarboxazid. Mechanism: unknown. Minor/Significance Unknown. Risk of delirium (case report).
• linezolid disulfiram, linezolid. Mechanism: unknown. Minor/Significance Unknown. Risk of delirium (case report).
• meloxicam disulfiram will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• metronidazole topical disulfiram increases toxicity of metronidazole topical by decreasing metabolism. Minor/Significance Unknown. Enhanced CNS & cardiac toxicity with oral metronidazole and disulfiram; less likely to occur with topical administration because of low absorption.
• metronidazole vaginal disulfiram increases toxicity of metronidazole vaginal by decreasing metabolism. Minor/Significance Unknown. Enhanced CNS & cardiac toxicity with oral metronidazole and disulfiram; less likely to occur with vaginal administration because of low absorption.
• phenelzine disulfiram, phenelzine. Mechanism: unknown. Minor/Significance Unknown. Risk of delirium (case report).
• phenytoin disulfiram increases levels of phenytoin by decreasing metabolism. Minor/Significance Unknown.
• piroxicam disulfiram will increase the level or effect of piroxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• ramelteon disulfiram will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• ruxolitinib disulfiram will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
• ruxolitinib topical disulfiram will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
• sevoflurane disulfiram will increase the level or effect of sevoflurane by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• sulfamethoxazole disulfiram will increase the level or effect of sulfamethoxazole by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• theophylline disulfiram increases levels of theophylline by decreasing metabolism. Minor/Significance Unknown.
• tolbutamide disulfiram will increase the level or effect of tolbutamide by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• voriconazole disulfiram will increase the level or effect of voriconazole by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.

• acetaminophen Minor (1) disulfiram will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• acetaminophen IV Minor (1) disulfiram will increase the level or effect of acetaminophen IV by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• acetaminophen rectal Minor (1) disulfiram will increase the level or effect of acetaminophen rectal by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• alosetron Minor (1) disulfiram will increase the level or effect of alosetron by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• alprazolam Monitor Closely (1) disulfiram increases levels of alprazolam by decreasing metabolism. Use Caution/Monitor.
• atogepant Monitor Closely (1) disulfiram will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• avapritinib Monitor Closely (1) disulfiram will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• axitinib Monitor Closely (1) disulfiram increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• benznidazole Contraindicated (1) benznidazole, disulfiram. Either increases toxicity of the other by aldehyde dehydrogenase inhibition. Contraindicated. Psychotic reactions have been reported in patients who were coadministered disulfiram and nitroimidazole agents (structurally related to benznidazole). Do not prescribe benznidazole to patients who have taken disulfiram within the last 2 weeks.
• bosentan Minor (1) disulfiram will increase the level or effect of bosentan by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• brexpiprazole Monitor Closely (1) disulfiram will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
• carbamazepine Serious - Use Alternative (1) carbamazepine, disulfiram. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.
• celecoxib Minor (1) disulfiram will increase the level or effect of celecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• chlordiazepoxide Minor (1) disulfiram increases levels of chlordiazepoxide by decreasing metabolism. Minor/Significance Unknown.
• cholic acid Monitor Closely (1) disulfiram increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.
• clonazepam Monitor Closely (1) disulfiram increases levels of clonazepam by decreasing metabolism. Use Caution/Monitor.
• clorazepate Monitor Closely (1) disulfiram increases levels of clorazepate by decreasing metabolism. Use Caution/Monitor.
• cocaine topical Monitor Closely (1) disulfiram increases levels of cocaine topical by unknown mechanism. Use Caution/Monitor.
• dapsone Minor (1) disulfiram will increase the level or effect of dapsone by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
• diazepam Monitor Closely (1) disulfiram increases levels of diazepam by decreasing metabolism. Use Caution/Monitor.
• diclofenac Minor (1) disulfiram will increase the level or effect of diclofenac by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
• dronabinol Contraindicated (1) disulfiram increases toxicity of dronabinol by aldehyde dehydrogenase inhibition. Contraindicated. Dronabinol oral solution (Syndros) contains 50% (w/w) dehydrated alcohol 5.5% (w/w) propylene glycol, which can produce disulfiramlike reactions if coadministered. Discontinue disulfiram at least 14 days before starting dronabinol solution and do not administer disulfiram within 7 days of completing treatment with dronabinol solution.
• eliglustat Contraindicated (1) disulfiram increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.
• ethanol Serious - Use Alternative (2) disulfiram will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug.