Drug for alcohol use disorder, aldehyde dehydrogenase inhibitor
ATC code: N07BB01 (Disulfiram)
Brand names
Antabuse
Irreversibly inhibits mitochondrial aldehyde dehydrogenase (ALDH2). With alcohol intake, acetaldehyde accumulates and causes nausea, vomiting, facial flushing, tachycardia, hypotension and anxiety – the disulfiram-ethanol reaction. Also inhibits dopamine beta-hydroxylase and CYP2E1. Effect persists 7–14 days after withdrawal.
Second line
Disulfiram is used in chronic alcohol use disorder as a second-line drug after naltrexone and acamprosate. Prescribed for motivated patients ready for full abstinence, usually combined with psychotherapy and a support group. SOCIDROGALCOHOL stresses mandatory patient education about the alcohol reaction and supervised dosing (often by a family member).
2 pairs found. Sorted from critical to minor.
Mechanism
Both inhibit ALDH. Combined use accumulates acetaldehyde and causes psychosis with hallucinations, delirium and fatal neurological complications. boxed warning.
Symptoms
Psychosis, hallucinations, delirium within 1-3 days.
Management
Combination contraindicated. Do not give metronidazole within 14 days after disulfiram withdrawal.
Mechanism
Disulfiram inhibits CYP2C9 and CYP2C19. Phenytoin rises 2-3 fold – toxicity (nystagmus, ataxia).
Symptoms
Nystagmus, ataxia, dizziness within 5-7 days.
Management
Check phenytoin level at 5 and 14 days. Reduce dose 30-50%.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Limited data. Use only if benefit outweighs risk.
No milk excretion data. Breastfeeding not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Disulfiram is evaluated for the following indications with varying evidence strength: Alcohol use disorder (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Disulfiram (≥ 1 in 100): Drowsiness, Metallic taste, Skin rash, Decreased libido. See the Safety section for uncommon and serious reactions.
FDA category C. Limited data. Use only if benefit outweighs risk.
No milk excretion data. Breastfeeding not recommended.
Disulfiram is contraindicated in: Alcohol intake in any form (including syrups, mouthwashes, alcohol-containing medicines); Combination with metronidazole, tinidazole (fatal psychosis); Severe hepatic impairment; Psychosis, severe depression; Ischemic heart disease. Full list in the Safety section.