Information disulfiram medication

Disulfiram medication (Refusal or Antabuse) is available in dosages of 250mg and 400mg. These dosages are too high to start on a responsible dose without side-effects and lower dosages are required to (I) start with a low dose and (II) increase the dose with small steps.
The traject of increase should be established in consultation between practitioner and patient.
In order to increase the dose of disulfiram in an accurate way and on a gradual scale the patient needs the lower dosages which are compounded by a pharmacist.

For an accurate treatment it is advised to spread the dosage throughout the day. Therefore half of the dosage should be taken in the morning and the other half should be taken in the evening.
If the dosage is not exactly divisible into two equals, please divide as far as possible without breaking pills. Example: 25mg means 15mg in the morning and 10mg in the evening.

Regenboog Apotheek Bavel (Netherlands) is a compounding pharmacy which can provide the disulfiram in other dosages than the registered dosages.
All these dosages of disulfiram are tablets/pills:

• 200mg
• 100mg
• 50mg
• 20mg
• 5mg

With these dosages a gradual scale can be achieved in order to set up the patient in accordance with the consulted traject.
These tablets/pills will be delivered in a strip so the patient only needs to use one pouch per moment of intake. This pouch contains the prescribed dose.
On every pouch is printed which tablets/pills are in the pouch and on wich day they should be taken.

Prescribing and ordering disulfiram medication

1. Disulfiram-strips are only available on prescription. The signed order form is considered a prescription.
2. Disulfiram-strips should not be seen as a replacement for the usual patient care provided by a doctor. Adequate support of patients during the traject, but also for some time afterwards, remains essential for timely recognition of any important signs.
3. Disulfiram-strips are a tool to make it easier for both the patient and doctor to achieve a required dose.
4. In consultation with the treating practitioner, the patient can select from the different schedules on the order form.
5. After signing the form, the practitioner should fax it to the Regenboog Apotheek (Rainbow Pharmacy). The fax number is stated on the order form.
6. The medication is sent by post to the patient’s home address, generally within a week. The patient and the doctor are informed of this shipment by email.
7. In principle, disulfiram-strips can also be sent to patients outside of the Netherlands, in accordance with legislation for that country.
8. After using one or more disulfiram-strips, the patient receives a short questionnaire and return envelope asking them about their experiences with the strips. This information will help to improve the use of disulfiram-strips in the future.
9. The order form for disulfiram-strips is listed below. To order disulfiram-strips for one of the trajects or for more information, please contact Paul Harder, pharmacist at the Regenboog Apotheek by email of phone +31 (0)6-2507 2020.