Disulfiram — MRCPsych Paper B MCQ
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Correct answer: C — Disulfiram
Disulfiram is the correct answer. It irreversibly inhibits acetaldehyde dehydrogenase, causing acetaldehyde to accumulate when alcohol is consumed. This produces the disulfiram–alcohol reaction, with flushing, nausea, vomiting, palpitations and potentially severe hypotension or arrhythmias. Acamprosate modulates glutamatergic and GABA-related neurotransmission and supports abstinence without causing an alcohol-aversive reaction. Naltrexone is an opioid-receptor antagonist that reduces alcohol-related reward and relapse risk. Methadone is a full opioid agonist, while buprenorphine is a partial opioid agonist; both are principally used in opioid-dependence treatment rather than as aversive treatments for alcohol dependence.
Reference: Electronic Medicines Compendium, Disulfiram 200 mg tablets, Summary of Product Characteristics, sections 4.8 and 5.1, updated 2025. https://www.medicines.org.uk/emc/product/11168/smpc