Disulfiram (Antabuse)
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
