What is the recommended dosage of disulfiram (Antabuse) for treating alcoholism?

Disulfiram Dosage for Alcoholism Treatment

The recommended dosage of disulfiram (Antabuse) for treating alcoholism is an initial dose of 500 mg daily for 1-2 weeks, followed by a maintenance dose of 250 mg daily (range 125-500 mg), not exceeding 500 mg daily. 1

Initial Dosing Protocol

• First phase: 500 mg daily in a single dose for 1-2 weeks
• Maintenance phase: Average 250 mg daily (range 125-500 mg)
• Administration timing: Usually taken in the morning, but can be taken at bedtime if sedation occurs
• Important prerequisite: Patient must be alcohol-free for at least 12 hours before starting disulfiram 1

Dosage Adjustments

• If sedative effects are problematic, dosage may be adjusted downward
• Some patients may require higher maintenance doses (up to 500 mg daily) if they report ability to consume alcohol without experiencing a reaction 1
• For older patients or those with liver concerns, consider starting at lower doses

Duration of Treatment

Disulfiram treatment should be continued daily and uninterrupted until:

• The patient has fully recovered socially
• A basis for permanent self-control is established
• Depending on individual needs, maintenance therapy may be required for months or years 1

Monitoring Compliance

• Ensure patients are reliably taking their medication
• Consider crushing tablets and mixing with liquid if compliance is questionable
• Supervised administration may improve outcomes 2

Cautions and Contraindications

• Liver disease: Disulfiram is not recommended in patients with alcoholic liver disease due to risk of hepatotoxicity 3, 4
• Age consideration: Test reactions with alcohol should never be administered to patients over 50 years of age 1
• Psychiatric risk: Use the lowest effective dose (250 mg daily) to minimize risk of psychosis, especially in patients with personal or family history of psychotic disorders 5

Alternative Medications for Patients with Liver Disease

For patients with alcoholic liver disease where disulfiram is contraindicated:

• Baclofen: Recommended first-line option for patients with liver cirrhosis (10 mg three times daily) 3
• Acamprosate: Alternative with no hepatic metabolism (666 mg three times daily for patients ≥60 kg) 3, 4

Effectiveness Considerations

• Disulfiram is most effective when:
  • Combined with counseling and other alcoholism therapies 6
  • Compliance is supervised 2
  • Used in patients who are older, socially stable, and well-motivated 6
• Disulfiram may help reduce drinking frequency after relapse but does not necessarily enhance complete abstinence rates 2

Management of Disulfiram-Alcohol Reaction

For severe reactions due to alcohol consumption while on disulfiram:

• Provide supportive measures to restore blood pressure and treat shock
• Administer oxygen, vitamin C intravenously (1 g), and ephedrine sulfate as needed
• Monitor potassium levels, particularly in patients on digitalis 1

Remember that disulfiram is only an adjunctive therapy and should be used as part of a comprehensive treatment approach that includes support, supervision, and other therapeutic measures.