disulfiram
Last reviewed 2025-12-30
Reviewed by PsychMed Editorial Team.
Brands: Antabuse
Sources updated 2025 • 4 references
General Information
Disulfiram (brand Antabuse; generics) is an aversive-therapy medication for alcohol use disorder (AUD). It inhibits aldehyde dehydrogenase so alcohol exposure can trigger an acetaldehyde reaction (label).
Because the clinical effect depends on consistent adherence, outcomes are best when dosing is supervised or strongly supported and when the goal is abstinence (guideline/clinical).
Disulfiram is not a withdrawal treatment; alcohol withdrawal is managed separately, then relapse-prevention options are considered during ongoing recovery care (guideline/clinical).
Key safety issues include severe reactions with alcohol exposure, hepatotoxicity risk, and medication interactions (label/clinical).
The compare view, disulfiram evidence feed, and disulfiram print page support counseling when abstinence-focused options are being weighed against side effects and practical constraints.
U.S. approvals
- Adjunct in the management of chronic alcohol use disorder (label) ()
Formulations & strengths
- Oral tablets (label): 250 mg, 500 mg.
Generic availability
- Generic available in the U.S.
Often reserved for selected patients when abstinence is the goal and when supervised dosing is feasible. Hidden alcohol exposure and hepatotoxicity monitoring are common barriers to use.
View labelExactMechanism of Action
Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.
Inhibits aldehyde dehydrogenase, leading to acetaldehyde accumulation after alcohol ingestion and an aversive physiologic reaction (label).
The aversive mechanism relies on consistent dosing and consistent alcohol avoidance; it does not directly treat cravings in the way some other options may (review/guideline).
- Aldehyde dehydrogenase inhibition (aversion mechanism).
Metabolism and Pharmacokinetics
- Undergoes hepatic metabolism to diethyldithiocarbamate and other metabolites; pharmacodynamic effects can persist after stopping (label/clinical).
- Label advises continued alcohol avoidance for up to 14 days after discontinuation because reaction risk can persist (label).
Dosing and Administration
- Typically administered once daily; supervised dosing improves adherence and is associated with better outcomes in many settings (label/clinical).
- Label guidance includes an alcohol-free interval before initiation and continued alcohol avoidance after stopping (label).
Monitoring & Labs
- Confirm alcohol abstinence at initiation and review “hidden alcohol” sources and emergency planning (label/clinical).
- Liver monitoring: baseline assessment and follow-up labs are commonly used, especially early in treatment or if symptoms of hepatitis appear (label/clinical).
- Track adherence and consider supervised dosing when feasible because missed doses reduce effectiveness (guideline/clinical).
- Review medication list for interactions at each visit and when new OTC products are started (label/clinical).
Many programs document informed consent about reaction severity and avoidance of alcohol for up to 14 days after discontinuation (label).
Adverse Effects
FDA boxed warnings
Common side effects (≥10%)
- Fatigue / headache: Common non-specific effects that can overlap with early recovery symptoms; clinicians often reassess tolerability during initiation (label/clinical).
- Dermatologic reactions: Rash and dermatitis can occur; discontinuation may be needed if reactions are severe (label).
- GI symptoms: Nausea and metallic/garlic taste are reported and may affect adherence (label/clinical).
Other notable effects
- Alcohol-disulfiram reaction can be severe (hypotension, chest pain, arrhythmias, altered mental status), especially in people with cardiac disease; emergency evaluation is appropriate if severe symptoms occur (label/clinical).
- Hepatotoxicity can occur, including hepatitis and liver failure; many programs monitor liver enzymes at baseline and early in treatment (label/clinical).
- Peripheral neuropathy and neuropsychiatric symptoms are reported and can prompt reassessment (label/clinical).
Interactions
- Alcohol-containing products (OTC medications, mouthwash, some foods and topical preparations) can trigger the reaction; counseling often includes a “hidden alcohol” checklist (label/clinical).
- Disulfiram interacts with multiple medications (including metronidazole and some anticoagulants), so medication reconciliation is a routine part of prescribing (label).
Other Useful Information
- Evidence reviews suggest disulfiram’s effectiveness is strongly linked to supervised dosing and patient selection; it is commonly positioned after first-line options when abstinence is the primary goal (review/guideline).
- Disulfiram is often discussed as a “commitment” medication: it can be helpful when a person prefers an abstinence-focused plan with strong accountability supports (observed dosing, family involvement with consent, structured follow-up), but it is less effective when adherence is inconsistent (review/clinical).
- In practice, disulfiram decisions are often paired with treatment for co-occurring insomnia, anxiety, and depression, because symptom relief can reduce relapse risk during early recovery (clinical).
References
- Disulfiram tablets prescribing information — DailyMed (2025)
- Pharmacotherapy FOR Adults With Alcohol USE Disorders IN Outpatient Settings: A Systematic Review AND Meta Analysis — JAMA (2014)
- The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder — American Journal of Psychiatry (2018)
- Anticraving therapy for alcohol use disorder: A clinical review — Neuropsychopharmacology Reports (2018)