Disulfiramlike Reaction

Disulfiram irreversibly inhibits aldehyde dehydrogenase, by competing with nicotinamide adenine dinucleotide at the cysteine residue. Aldehyde dehydrogenase is a hepatic enzyme of alcohol metabolism converting ethanol to acetaldehyde. At therapeutic doses of disulfiram, alcohol consumption causes elevated serum acetaldehyde, causing manifestations given below.

Manifestations

• Diaphoresis
• Facial flushing
• Hypotension
• Nausea
• Palpitations
• Tachycardia
• Vertigo

We call this constellation of symptoms the disulfiram-alcohol reaction; it discourages alcohol intake. The severity of the reaction is proportional to the dose of disulfiram, and that of alcohol. It is NOT an anti-craving drug and DOES NOT affect the neurobiology of addiction.

NICE guidelines on the Use of Disulfiram

Disulfiram should be considered in combination with a psychological intervention for patients who wish to achieve abstinence, but for whom acamprosate or naltrexone is not suitable. Treatment should be started at least 24 hours after the last drink and should be overseen by a family member or a carer. Monitoring is recommended every 2 weeks for the first 2 months, then monthly for the following 4 months. Medical monitoring should be continued at 6 monthly intervals after the first 6 months. Patients must not consume any alcohol while taking disulfiram