Disulfiram
ANTABUSE
Pronunciation: dye-SUL-fi-ram
“Ant abuse; Die sufferin’”
What it isIrreversible aldehyde dehydrogenase inhibitor; alcohol use disorder.
Why this oneIt works by deterrence rather than craving reduction, which suits supervised administration.
What limits itThe alcohol reaction can be severe and requires full informed consent and avoidance of hidden alcohol. Hepatotoxicity and neuropathy.
FDA-approved for
- alcohol use disorder (1951)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Adjunct in management of chronic alcoholism (support abstinence) | Adult | Up to 500 mg QD x1–2 weeks | 250 mg QD (range 125–500 mg) | 500 mg/day |
Renal Undefined
Hepatic Undefined
Instructions
- Never administer until the patient has abstained from alcohol for at least 12 hours
- May take at bedtime if sedating; adjust dose downward to minimize sedation
- Continue daily, uninterrupted; maintenance may be required for months to years
Available strengths
- tab 250, 500 mg
Contraindications
- Recent or current metronidazole
- Recent or current paraldehyde
- Alcohol or alcohol-containing preparations (e.g., cough syrups, tonics)
- Severe myocardial disease or coronary occlusion
- Psychoses
Cautions
- Hepatotoxicity — hepatitis and hepatic failure (transplant/death reported)
- Optic neuritis, peripheral neuritis/neuropathy
- Psychotic reactions (esp. high dose or combined toxicity)
- Disulfiram-alcohol reaction — can be severe
Adverse reactions
- Drowsiness/fatigability
- Impotence
- Headache
- Acneform eruptions, allergic dermatitis
- Metallic or garlic-like aftertaste
- Optic/peripheral neuritis
- Hepatitis
Pregnancy Safe use in pregnancy not established; use only if probable benefits outweigh possible risks.
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 250 mg | tab | 30 qd | $54.70 | offered |
| 500 mg | tab | 30 qd | $399.43 | not offered |
Generic entry1983
⚠ BOXED WARNING
- Never administer to an intoxicated patient or without their knowledge
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
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