Drug reference

Disulfiram

Antidote · Substance dependence

Also known as Antabuse, Esperal

AntidoteSubstance dependence

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

High concentrations of acetaldehyde which occur in presence of alcohol may be teratogenic; avoid in first trimester

FDA category + note

Top interactionssee all 12 →

LopinavirContraindicatedTextbookG&G 14e · p1245-1266
MetronidazoleContraindicatedDatabaseKimi deep-research + Cla
TinidazoleContraindicatedDatabaseKimi deep-research + Cla
BarbituratesSevereTextbookG&G 14e · p528

Mechanism

Disulfiram is an aldehyde dehydrogenase inhibitor. This inhibition leads to the accumulation of acetaldehyde, a toxic metabolite of alcohol, when alcohol is consumed. The resulting high concentrations of acetaldehyde cause unpleasant and potentially life-threatening symptoms, which discourages alcohol intake.

Indications

Adjunct in the treatment of alcohol dependence (under expert supervision)alcohol use disorder (for patients committed to sustained abstinence)Alcohol use disorder treatmentAlcohol aversion therapy in abstinent subjects who sincerely desire to leave the habitadjuvant in comprehensive treatment programmes for alcohol dependence

Dosing

Adult: Oral: 200 mg daily, increased if necessary up to 500 mg daily
Renal adjustment: Use with caution
Hepatic adjustment: Manufacturer advises caution
Max dose: 500 mg daily

Pharmacokinetics

Duration

Inhibition of aldehyde dehydrogenase lasts for 7-14 days.

Metabolism

Inhibits a number of other enzymes as well including alcohol dehydrogenase, dopamine β hydroxylase and several cytochrome P450 isoenzymes. Thus, it prolongs t½ of many drugs.

Contraindications

Cardiac failure
coronary artery disease
history of cerebrovascular accident
hypertension
psychosis
severe personality disorder
suicide risk
Acute porphyrias
cardiovascular disease
liver disease (use with caution)
recent alcohol consumption (must abstain for at least 12 hours prior to administration)
Patients who are physically dependent on alcohol

Side effects

Common

Allergic dermatitisbreath odourdepressiondrowsinessfatiguelibido decreasednauseanerve disordersvomitingsedation (most common)flushingthrobbing headacherespiratory difficultiessweatingthirstchest painhypotensionorthostatic syncopeweaknessvertigoblurred visionconfusionUnpleasant flushing reaction (when alcohol is consumed)Nausea (when alcohol is consumed)Rashesmetallic tastenervousnessmalaiseabdominal upset

Serious

Flushing
palpitations
arrhythmias
hypotension
respiratory depression
coma
Fever
Jaundice
Hepatocellular injury
Encephalopathy
Psychotic disorder
Mania
Paranoia
Aldehyde syndrome (flushing, burning sensation, throbbing headache, perspiration, uneasiness, tightness in chest, dizziness, vomiting, visual disturbances, mental confusion, postural fainting, circulatory collapse) when taken with alcohol.

Pregnancy & lactation

Pregnancy

High concentrations of acetaldehyde which occur in presence of alcohol may be teratogenic; avoid in first trimester

Lactation

Avoid—no information available

Drug interactions

Lopinavir

Contraindicated

Textbook

Disulfiram-like reaction.

Should not be administered with disulfiram.

Source: G&G 14e · p1245-1266

Metronidazole

Contraindicated

Database

Psychotic reactions (acute confusional state, paranoid delusions) have occurred in patients taking metronidazole concurrently with disulfiram or within 14 days of disulfiram.

Do not administer metronidazole to patients who have taken disulfiram within the past 14 days. Wait at least 2 weeks after stopping disulfiram before starting metronidazole.

Source: Kimi deep-research + Cla

Tinidazole

Contraindicated

Database

Psychotic reactions reported; both drugs affect alcohol metabolism

Do not use within 2 weeks of disulfiram

Source: Kimi deep-research + Cla

Barbiturates

Severe

Textbook

Increased barbiturate levels, potentially leading to increased CNS depression or toxicity.

Monitor for increased CNS depression. Dose adjustment of barbiturates may be necessary.