ALDH Inhibitor·Addiction Medicine

Disulfiram

Alcohol-deterrent aid in the overall management of selected chronic alcohol-dependent patients who are motivated to abstain and engaged in counselling/psychiatric support

AUDAntabuse200 mg tabletS4TGA

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At a glance

Max Dose

300 mg/day

Half-life

60-120 h

High risk: Alcohol Reaction

FATAL RISK

High risk: Hepatotoxicity

CRITICAL

Cautions

Avoid / Cautions

Contraindicated in pregnancy, severe myocardial/ischaemic heart disease, uncompensated cardiac failure, previous CVA, hypertension, advanced liver or renal disease, psychosis/psychotic states, suicidal risk, serious organic brain damage, intoxication, metronidazole/paraldehyde use, hypersensitivity, or no informed consent.

Where it stands

Rapid Summary

Overview

Aversive alcohol-deterrent medicine for selected motivated abstinent patients receiving counselling/psychiatric support. It does not reduce craving; it creates risk of a severe reaction if alcohol is consumed.

Clinical Focus

Use only with informed consent, clear abstinence, and strict counselling about hidden alcohol sources. Alcohol reactions can be severe, unpredictable, and rarely fatal.

Bottom Line

Disulfiram is an alcohol deterrent causing severe acetaldehyde reaction with any alcohol intake, but requires strict patient motivation and compliance and has hepatotoxicity risk.

Formulation & Access

Brand Names

Antabuse

Oral Routes

Effervescent tablets containing disulfiram 200 mg.

Prescribing & PBS

S4 prescription medicine. PBS search did not identify a disulfiram item on the checked date; recheck PBS before making subsidy/access claims.

Indications & Use

Primary

TGA

Alcohol-deterrent aid in the overall management of selected chronic alcohol-dependent patients who are motivated to abstain and engaged in counselling/psychiatric support.

Clinical Place

Third-line behind Acamprosate and Naltrexone. Used only when fear of violent sickness is required to stop impulsive drinking.

Quick reference

Class & Role

ALDH Inhibitor — Aldehyde dehydrogenase inhibitor.

Route / Formulation

Tablets (200 mg). (Antabuse)

Usual Dose & Max

Initial: 100 mg daily for 7-14 days, then increase if required to max 300 mg/day. Maintenance is usually 200 mg daily for 6 weeks to 6 months; review before longer-term use.

Key Indication Doses

Alcohol-deterrent therapy only for selected motivated abstinent patients in an integrated counselling/psychiatry program. Must abstain from alcohol for at least 24 h before starting and for at least 14 days after stopping; reactions may occur up to 3 weeks.

Best Uses

Disulfiram is an alcohol deterrent causing severe acetaldehyde reaction with any alcohol intake, but requires strict patient motivation and compliance and has hepatotoxicity risk.

Key Risks

Cardiovascular / Systemic: Disulfiram-Alcohol Reaction: Throbbing headache, violent vomiting, severe flushing, dyspnea, tachycardia, hypotension, myocardial infarction, and cardiovascular collapse. Hepatic: Idiosyncratic, fatal fulminant hepatitis (Can occur even without alcohol consumption). Neurological: Peripheral neuropathy, optic neuritis, psychosis (due to inhibition of dopamine beta-hydroxylase).

Key Interactions

Alcohol and alcohol-containing products are contraindicated. Avoid metronidazole and paraldehyde. Phenytoin levels can rise; disulfiram-alcohol reaction intensity may be increased by amitriptyline or chlorpromazine. Warfarin/INR interaction should be checked locally.

Monitoring

Confirm informed consent and alcohol abstinence before first dose. Check LFTs before treatment and periodically; monitor for hepatitis, neuropathy, optic neuritis, mood/psychotic symptoms, and hidden alcohol exposure.

Clinical Pearl

Disulfiram does not reduce cravings; it works entirely on fear. It is most effective when administration is directly supervised by a spouse or clinic, ensuring the patient cannot 'choose' not to take it when they want a drink.

Access

Antabuse200 mg tablet

Brand: Antabuse
Formulation: Effervescent tablets containing disulfiram 200 mg.

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Cautions

Avoid / Cautions