disulfiram: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
disulfiram: clinical details
Prescribing considerations
- Initiate through an experienced specialist service after confirming suitability, informed consent and a clear abstinence goal.
- Assess physical and mental health, suicide risk, alcohol exposure, social support and the complete medication list.
- Warn patients and supporters about hidden alcohol sources and persistent reaction risk after discontinuation.
- Alcohol challenge testing is not routinely recommended because severe reactions can occur.
Contraindications and cautions
- Uncompensated cardiac failure, coronary artery disease, previous cerebrovascular accident or hypertension.
- Psychosis, severe personality disorder or suicidal risk.
- Current alcohol consumption.
- Hypersensitivity to disulfiram or product excipients.
- Use caution with renal failure, reduced hepatic function, respiratory disease, diabetes, hypothyroidism, cerebral damage or epilepsy.
Monitoring
- Check liver function before treatment and periodically thereafter; discontinue and assess promptly if liver injury or jaundice is suspected.
- Assess renal function and other investigations according to medical history.
- Monitor adherence, abstinence, mental state, adverse effects and clinically significant interactions.
Clinical pharmacology
Disulfiram irreversibly inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation after ethanol exposure. It also inhibits dopamine-beta-hydroxylase and hepatic enzyme systems. Oral absorption is variable, and metabolites are mainly renally excreted.
Formulation and product differences
- The selected product is an uncoated, scored tablet that can be divided into equal halves.
- It contains lactose and is essentially sodium-free.
- It is supplied in a bottle and should be stored below 25°C.
disulfiram preparations and strengths
Tablet
Route: Oral
Strengths: 200 mg
disulfiram interactions
Check all prescribed, over-the-counter and liquid products because disulfiram can alter hepatic drug metabolism.
Alcohol and alcohol-containing products
May cause an unpredictable, potentially life-threatening disulfiram–alcohol reaction.
Warfarin and similar anticoagulants
Their anticoagulant effect may increase, requiring closer monitoring and possible adjustment.
Phenytoin or theophylline
Reduced metabolism may increase effects and toxicity, so monitoring and adjustment may be needed.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.