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Alcohol Deterrent (Aldehyde Dehydrogenase Inhibitor) Pregnancy: Use in the first trimester of pregnancy is not advised; the risk/benefit ratio of the adverse effects of alcoholism in pregnancy should be taken into account when considering use in pregnant patients. There have been rare reports of congenital abnormalities in infants whose mothers received disulfiram in conjunction with other medicines. Breast-feeding: should not be used — no information on excretion in breast milk, and use during breast-feeding is not advised, especially where there is a possibility of interaction with medicines the baby may be taking. Fertility: no data available.

Disulfiram

Brand names: Antabuse

Disulfiram is an aversive agent used as an adjunct in the maintenance of abstinence in alcohol dependence.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Day 1: no more than 800 mg (4 x 200 mg tablets) as a single dose; day 2: 600 mg (3 tablets); day 3: 400 mg (2 tablets); days 4 and 5: 200 mg (1 tablet). Then maintenance 100–200 mg daily (half a tablet or 1 tablet)
Route: Oral
Frequency: Once daily
Max: 800 mg on the first day of treatment (the SPC states the patient should be given no more than 4 x 200 mg tablets in one dose on day 1). Maintenance should continue for no longer than six months without review
Source: UK SPC (eMC) for Disulfiram 200 mg tablets, §4.2 (https://www.medicines.org.uk/emc/product/11168/smpc). Doses above are expressed in mg from the SPC's tablet counts of the 200 mg tablet ('4 tablets ... in one dose (800 mg)', then 3, then 2, then 1, then '1 or half a tablet daily'). INDICATED POPULATION: adults and elderly patients only. INITIATION: treatment should be initiated only in a hospital or specialised clinic and by physicians experienced in its use. The patient should have adequate social and family support to avoid ingestion of alcohol. Suitable patients should not have ingested alcohol for at least 24 hours and must be warned that a disulfiram-alcohol reaction is potentially dangerous. DURATION: subsequent daily dosing should continue at 1 or half a tablet daily for as long as advised by the physician, but no longer than six months without review. ALCOHOL CHALLENGE: in routine management it is NOT recommended to carry out an alcohol challenge test; if the clinician feels one is essential, full information on the procedure and risks must be obtained from the company, and as severe reactions can occur any alcohol challenge should be carried out in specialised units by physicians acquainted with the procedure, with full resuscitation facilities immediately available. PAEDIATRIC: 'There is no relevant use of Disulfiram in the paediatric population' (§4.2) — no paediatric dose is stated and none should be inferred; verify any under-18 use against a children's formulary. §4.4 MONITORING: liver function should be monitored before initiation and periodically thereafter; consider discontinuation if symptoms or signs of liver injury associated with jaundice occur. Alcohol must not be consumed during treatment and for up to 14 days after discontinuation; certain foods, liquid medicines, remedies, tonics, toiletries, perfumes and aerosol sprays, and low-alcohol/'alcohol-free' beers and wines, may contain enough alcohol to elicit a reaction. Caution in renal failure, reduced hepatic function, respiratory disease, diabetes mellitus, hypothyroidism, cerebral damage and epilepsy. Contains lactose. METHOD OF ADMINISTRATION: oral. The §4.5 text in this bundle was truncated at the source-fetch limit — verify the complete interactions section.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Uncompensated cardiac failure
  • Coronary artery disease
  • Previous history of CVA (stroke)
  • Hypertension
  • Severe personality disorder; suicidal risk; psychosis
  • Consumption of alcohol
  • Hypersensitivity to disulfiram or to any of the excipients

Side effects

  • Drowsiness and fatigue during initial treatment (frequency not known)
  • Hepatic cell damage and drug-induced liver injury — fatal cases have been reported (frequency not known)
  • Psychotic reactions, depression, paranoia, schizophrenia, mania, reduced libido (frequency not known)
  • Peripheral neuritis, optic neuritis, encephalopathy (frequency not known)
  • Nausea and vomiting; halitosis; allergic dermatitis and rash (frequency not known)
  • Disulfiram-alcohol reaction (on ethanol exposure): flushing of face and neck, increased body temperature, sweating, nausea, vomiting, pruritus, urticaria, anxiety, dizziness, headache, blurred vision, dyspnoea, palpitations and hyperventilation; in severe cases tachycardia, hypotension, respiratory depression, chest pain, QT prolongation, ST depression, arrhythmias, coma and convulsions

Interactions

  • Alcohol — disulfiram blocks the metabolism of alcohol, leading to accumulation of acetaldehyde and the potentially severe disulfiram-alcohol reaction
  • Amitriptyline — may increase the intensity of the disulfiram-alcohol reaction
  • Chlorpromazine — while decreasing certain components of the disulfiram-alcohol reaction, may increase the overall intensity of the reaction
  • Benzodiazepines — disulfiram inhibits the metabolism of chlordiazepoxide and diazepam, enhancing their sedative effect (interaction not indicated for oxazepam); benzodiazepines may reduce the disulfiram-alcohol reaction
  • Drugs metabolised in the liver, e.g. phenytoin, theophylline and warfarin — disulfiram inhibits their metabolism and thereby enhances efficacy; dose adjustment may be necessary
  • Animal studies indicate similar inhibition of the metabolism of pethidine and morphine (SPC text truncated at this point in the fetched bundle)

Clinical monograph

How it works

It irreversibly inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde if alcohol is consumed, which produces an unpleasant flushing, headache, nausea and palpitation reaction that deters drinking.

Prescribing in practice

  • A severe and potentially fatal reaction can occur with even small amounts of alcohol, including that in foods, medicines and toiletries, so patient understanding and supervision are essential.
  • Contraindicated in cardiovascular disease, severe psychiatric illness and during pregnancy because of the risk of the alcohol-disulfiram reaction.
  • Rare hepatotoxicity has been reported, so liver function should be checked and the drug stopped if hepatic dysfunction develops.

Monitoring

Monitor liver function and blood pressure during treatment and review adherence and abstinence regularly.

Counselling the patient

  • Avoid all alcohol, including in foods, mouthwashes and over-the-counter medicines, throughout treatment and for a period after stopping.
  • Seek urgent help if you experience chest pain, severe flushing or breathlessness.
  • Treatment works best alongside psychological support and supervised administration.

Evidence & guidelines

Disulfiram is an established option for supervised relapse prevention, and NICE recommends it as an adjunct alongside psychosocial support in alcohol dependence.

Reference: NICE CG115 (Alcohol Dependence); NICE NG115; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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