Makindo Medical Notes

Disulfiram is a drug used to support the management of alcohol dependence. It is not first-line (acamprosate or naltrexone are preferred in UK practice), but can be considered if those are unsuitable or if the patient chooses. Always check the BNF for up-to-date prescribing information.

⚙️ Mode of Action

• Irreversibly inhibits aldehyde dehydrogenase (not alcohol dehydrogenase).
• This causes accumulation of acetaldehyde when alcohol is consumed.
• Acetaldehyde triggers unpleasant vasodilatory and autonomic symptoms (“disulfiram reaction”).
• Acts as a psychological deterrent — most effective in motivated patients with good support.

🎯 Indications

• Adjunct to psychosocial support in alcohol dependence to maintain abstinence.
• Consider when acamprosate/naltrexone are unsuitable or declined.
• Most effective when adherence can be supervised.

💊 Dosing – Disulfiram (Antabuse)

Regimen	Details
⚡ Initial (supervised)	• Up to 800 mg PO OD • Often given under supervision to demonstrate effect
🩺 Maintenance	• 100–200 mg PO OD (usually in the morning)
🚫 Alcohol Avoidance	• Avoid alcohol ≥24 h before starting • Continue avoidance for up to 14 days after stopping

⚠️ Contraindications

• Severe cardiovascular disease (e.g. IHD, arrhythmias, recent stroke).
• History of psychosis, suicidality, or severe personality disorder.
• Pregnancy and breastfeeding (unless specialist advice).
• Cognitive impairment or inability to understand risks.

🔎 Cautions

• Epilepsy.
• Chronic liver disease — monitor LFTs.
• Diabetes mellitus.
• Chronic respiratory disease (risk of severe reaction).
• Elderly patients — more prone to confusion and hypotension.

🩺 Side Effects

• Without alcohol: drowsiness, fatigue, GI upset, metallic/garlic-like taste.
• With alcohol (disulfiram reaction): nausea 🤢, flushing 🔴, palpitations ❤️, hypotension, severe headache 🤯.
• Severe reactions: arrhythmias, collapse, MI, convulsions.

📌 Patient Education

• Explain the disulfiram–alcohol reaction clearly before prescribing.
• Obtain informed consent and provide written information.
• Warn about hidden alcohol sources (e.g., cough syrups, sauces, mouthwashes, hand sanitiser).
• Encourage supervised administration (by family, carer, or clinic) to improve adherence.
• Emphasise ongoing psychosocial and community support alongside medication.

📚 References

• Summary of Product Characteristics
• BNF: Disulfiram
• NICE CG115: Alcohol-use disorders – diagnosis, assessment and management