Mechanism: Disulfiram (Antabuse┬«) interferes with degradation of alcohol, resulting in accumulation of acetaldehyde which, in turn, produces a very unpleasant reaction including flushing, nausea, and palpitations if the patient drinks alcohol. It’s available in oral form (once daily dosing).

Efficacy: The utility and effectiveness of disulfiram are considered limited because compliance is generally poor when patients are given it to take at their own discretion. It is most effective when given in a monitored fashion, such as in a clinic or by a spouse. (If a spouse or other family member is the monitor, instruct both monitor and patient that the monitor should simply observe the patient taking the medication and call you if the patient stops taking the medication for 2 days.) Some patients will respond to self-administered disulfiram, however, especially if they’re highly motivated to abstain. Others may use it episodically for high-risk situations, such as social occasions where alcohol is present.

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