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Back to Psychiatry Drug Index

Back to Aldehyde Dehydrogenase Inhibitors

Name: Disulfiram

Pregnancy Category C

Drug classes

  • Antialcoholic
  • Enzyme inhibitor

Mechanisms of action

Inhibits the enzyme aldehyde dehydrogenase, blocking oxidation of alcohol and allowing acetaldehyde to accumulate to concentrations in the blood 5-10 times higher than normally achieved during alcohol metabolism; accumulation of acetaldehyde produces the highly unpleasant reaction described below that deters consumption of alcohol.

Indications

Aids in the management of selected chronic alcoholics who want to remain in a state of enforced sobriety

Contraindications/cautions

Contraindicated in the presence of allergy to disulfiram or other thiuram derivatives used in pesticides and rubber vulcanization, severe myocardial disease or coronary occlusion; psychoses, current or recent treatment with metrondiazole, paraldehyde, alcohol, alcohol-containing preparations (eg, cough syrups, tonics).

Use caution in the presence of diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or dysfunction.

Adverse effects

Disulfiram-alcohol reaction: Flushing, throbbing in head and neck, throbbing headaches, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitations, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, confusion; severe reactions may include arrhythmias, cardiovascular collapse, acute congestive heart failure, unconsciousness, convulsions, myocardial infarction, death

Adverse Effects of Disulfiram

  • CNS: Drowsiness, fatigability, headache, restlessness, peripheral neuropathy, optic or retrobulbar neuritis
  • GI: Metallic or garliclike aftertaste, hepatotoxicity
  • Dermatologic: Skin eruptions, anceiform eruptions, allergic dermatitis
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