Disulfiram (Antabuse) Dosage and Treatment Plan for Chronic Alcoholism
Disulfiram should be administered at an initial dose of 500 mg daily for 1-2 weeks, followed by a maintenance dose of 250 mg daily (range 125-500 mg), and should only be used in alcohol-dependent patients without advanced alcoholic liver disease due to potential hepatotoxicity. 1
Initial Assessment and Preparation
- Ensure patient has abstained from alcohol for at least 12 hours before starting disulfiram
- Verify patient does not have advanced alcoholic liver disease (ALD) as disulfiram is contraindicated in these patients 2
- Confirm normal liver function tests before initiating therapy
- Educate patient thoroughly about:
- The disulfiram-alcohol reaction (flushing, headache, nausea, vomiting, hypotension)
- The importance of avoiding all alcohol-containing products
- The need for medication adherence
Dosing Protocol
Initial Phase
- 500 mg daily in a single dose for 1-2 weeks 1
- May be taken in the morning or at bedtime if sedation occurs
- Dose can be adjusted downward if sedative effects are problematic
Maintenance Phase
- 250 mg daily (range 125-500 mg) 1
- Maximum dose should not exceed 500 mg daily
- Uninterrupted daily administration must continue until patient is fully recovered socially
Duration of Therapy
- Long-term treatment is often necessary
- Maintenance therapy may be required for months or even years depending on individual patient needs 1
- Regular follow-up is essential to monitor compliance and efficacy
Monitoring and Follow-up
- Regular liver function tests to monitor for hepatotoxicity
- Verify medication compliance (preferably with supervised administration)
- Monitor for cardiac, hepatic, and neurologic toxicity 3
- Potassium levels should be monitored, particularly in patients on digitalis 1
Important Considerations
- Disulfiram is contraindicated in patients with advanced ALD due to potential side effects 2
- The medication should never be used alone but as part of a comprehensive treatment program
- Supervised administration significantly improves compliance and outcomes 4
- Disulfiram may help reduce drinking frequency after relapse but does not necessarily enhance continuous abstinence 5
Patient Selection Criteria
Disulfiram is most appropriate for:
- Patients without advanced liver disease
- Motivated individuals who understand and accept the consequences
- Patients who have failed with less structured approaches
- Those who can reliably take medication daily
Complementary Treatments
- Combine disulfiram with counseling and behavioral therapy for optimal outcomes 2, 6
- Brief motivational interventions should be routinely used alongside medication 2
- Consider participation in mutual help groups like Alcoholics Anonymous 6
Cautions
- Alcohol-disulfiram reactions can be severe and potentially life-threatening
- The previously common practice of conducting a "trial reaction" with alcohol is now largely abandoned and should never be performed in patients over 50 years of age 1
- Disulfiram has no proven effect on long-term alcoholism outcomes when used without accompanying education and counseling 3
Remember that disulfiram is only one component of a comprehensive alcoholism treatment plan, and its effectiveness depends heavily on patient compliance and concurrent psychosocial interventions.