Disulfiram Use in Alcohol Use Disorder

Indications and Contraindications

Disulfiram is contraindicated in patients with alcoholic liver disease according to clinical practice guidelines 1, 2

Disulfiram inhibits aldehyde dehydrogenase (ALDH), causing acetaldehyde buildup when alcohol is consumed 2
This buildup results in unpleasant symptoms including flushing, dizziness, nausea, vomiting, arrhythmia, dyspnea, and headache 2

Baclofen is the preferred medication for patients with alcoholic liver disease 1, 3
Baclofen has demonstrated safety and efficacy in promoting alcohol abstinence in patients with liver cirrhosis 3
In a randomized trial of patients with alcoholic cirrhosis, a 12-week course of baclofen (10 mg three times daily) improved rates of total alcohol abstinence and decreased relapse compared to controls 1
Acamprosate may be considered as it has no hepatic metabolism 1, 3
Acamprosate reduces withdrawal effects and craving for alcohol 2, 3
Recommended dosage of Acamprosate is 1,998 mg/day for patients ≥60 kg 2

Naltrexone is also not recommended for patients with alcoholic liver disease due to hepatotoxicity concerns 1, 2, 3
Pharmacotherapy should always be combined with psychosocial interventions for optimal outcomes 1, 3
Alcohol abstinence is the most important treatment for alcoholic liver disease as it improves survival and prevents progression to cirrhosis 3