Disulfiram
Antabuse
Aldehyde Dehydrogenase InhibitorGeneric availableTDM data
DESCRIPTION Disulfiram is an alcohol antagonist drug. CHEMICAL NAME: bis(diethylthiocarbamoyl) disulfide. STRUCTURAL FORMULA: Disulfiram occurs as a white to off-white, odorless, and almost tasteless powder, soluble in water to the extent of about 20 mg in 100 mL, and in alcohol to the extent of about 3.8 g in 100 mL. Each tablet for oral administration contains 250 mg disulfiram, USP. Tablets also contain colloidal silicon dioxide, anhydrous lactose, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, and stearic acid. structure
Compare Disulfiram →FDA-Approved Indications
- Adjunct in chronic alcohol use disorder — enforced sobriety with psychosocial treatment (adults)
Common Off-Label Uses
- Cocaine dependence (investigational)
What Sets This Drug Apart
- Aldehyde dehydrogenase inhibitor — causes severe aversive reaction (flushing, nausea, vomiting, hypotension) if alcohol is consumed, providing deterrent-based treatment
- Aversion mechanism is pharmacological, not motivational — effective only in highly motivated patients willing to take it daily; supervised administration improves outcomes
- Reaction can occur with ANY alcohol exposure including mouthwash, vanilla extract, and OTC medications containing alcohol
- Strong CYP2E1 inhibitor — increases levels of CYP2E1 substrates; also inhibits dopamine-beta-hydroxylase, which can cause psychosis in susceptible patients
- Very long half-life (60-120h); effects persist up to 2 weeks after discontinuation — patients must avoid alcohol for 14 days after stopping
Boxed Warning
WARNING Disulfiram should never be administered to a patient when he is in a state of alcohol intoxication, or without his full knowledge