Disulfiram

Also known as: Antabuse, tetraethylthiuram disulfide

Wellness

In plain English

Disulfiram (Antabuse) is an FDA-approved medicine for alcohol use disorder. It works by making people feel sick (flushing, nausea, palpitations) if they drink, which discourages drinking. It works best when someone else supervises the daily dose. It can affect the liver and interacts with alcohol in foods and products, so it must be used carefully under medical supervision.

The science

Disulfiram irreversibly inhibits aldehyde dehydrogenase, causing acetaldehyde to accumulate after alcohol intake and producing an aversive disulfiram-ethanol reaction (flushing, nausea, tachycardia, hypotension). It is FDA-approved for alcohol dependence. A meta-analysis of randomized trials found disulfiram effective versus controls particularly in open-label/supervised settings, where adherence can be assured, but not clearly superior in blinded trials—supervision is the key modifier (Skinner et al., 2014). Hepatotoxicity (rarely severe), neuropathy, and drug/alcohol interactions require monitoring; it is contraindicated with recent alcohol exposure. (It is also under investigation for oncology and infection repurposing.)

References

• Skinner MD et al., PLoS One 2014 (disulfiram in alcohol dependence: meta-analysis)