Disulfiram for long-term management of alcohol dependence
Disulfiram is a behavioural treatment used to deter patients from drinking by causing vomiting, facial flushing, pounding headache, palpitations, and a risk of elevated blood pressure if they drink (the ethanol–disulfiram reaction)Skinner, 2014. This reaction also occurs if the patient is exposed to any form of alcohol (including aftershaves, antiseptics, mouthwashes) while taking disulfiram. Adherence needs to be enhanced by regular dose supervision (typically by someone close to the patient).
Disulfiram may not be effective in people unconcerned about the prospect of vomiting; effectiveness may also be reduced by regular use of antiemetics or other drugs with antiemetic effects (eg some antipsychotics). Contraindications include coronary heart disease, angina, hypertension, significant cognitive impairment or dementia1, suicidal ideation and psychosis.
Disulfiram is best started before discharge, after planned withdrawal in a hospital or community facility and discussion with a specialist. Dose titration may be needed, and there are a number of precautions and drug–drug interactions to consider. Liver biochemistry is recommended because disulfiram can be hepatotoxic. A breathalyser reading to confirm no recent alcohol use is also advised before starting.