Disulfiram

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.