Key facts
- Type: Alcohol Deterrent · Aldehyde Dehydrogenase Inhibitor
- ATC Code: N07BB01
- Kenya EML 2023: Listed
- Level of Use: Level 4-6
This is health education, not medical advice. Never start, stop, or change a medication without speaking to a qualified healthcare professional first.
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Prescription Only Medicine
Must only be taken by a fully motivated, alcohol-free patient who understands the reaction that will occur if alcohol is consumed. Never given without full informed consent.
What it treats
Which conditions is Disulfiram used for?
Overview
What is Disulfiram?
Disulfiram works not by reducing the desire to drink, but by making the physical consequences of drinking extremely unpleasant. When someone taking disulfiram consumes even a small amount of alcohol, a very uncomfortable reaction occurs within minutes.
This reaction is the mechanism of treatment. Knowing it will occur creates a strong deterrent against drinking. Disulfiram only works in people who are genuinely motivated to stop drinking and who take the medicine voluntarily and consistently.
It is listed in Kenya’s Essential Medicines List 2023. It works best as part of a structured programme that includes counselling and psychosocial support.
How it works
What does it do in the brain?
Disulfiram blocks an enzyme called aldehyde dehydrogenase, which is responsible for breaking down acetaldehyde, a toxic byproduct of alcohol metabolism. When alcohol is consumed while taking disulfiram, acetaldehyde builds up in the blood and causes the intensely unpleasant disulfiram-alcohol reaction.
Formulations in Kenya
How is it available?
Tablet 200 mg, 400 mg Taken by mouth Available at Level 4 to 6
Availability across Africa
Where is it available in Africa and what is it called?
Names and availability vary by country. Always confirm with a local pharmacist or healthcare provider.
| Country | Common Brand Name(s) | Notes |
|---|---|---|
| South Africa | Antabuse, Disulfiram (generic) | Available on prescription; used in structured alcohol treatment programmes. |
| Nigeria | Antabuse | Available at select teaching hospital pharmacies and private addiction treatment centres. |
| Ghana | Disulfiram (generic) | Available at Korle-Bu and through select addiction services in Accra. |
| Uganda | Antabuse, Disulfiram | Available at Butabika Hospital and some private pharmacies in Kampala. |
| Tanzania | Disulfiram (generic) | Available at Muhimbili National Hospital as part of alcohol use disorder treatment. |
Side effects
What might you feel while taking it?
These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.
- Metallic or garlic-like taste in the mouth
- Fatigue and drowsiness
- Headache
- Mild skin rash
- Reduced libido
Go to a doctor or emergency room straight away if you notice any of the following.
- The disulfiram-alcohol reaction, flushing, violent nausea and vomiting, rapid heart rate, severe headache, breathing difficulty, and a drop in blood pressure. This can be severe enough to require emergency care.
- Hidden alcohol in food, medicines, and toiletries can trigger the reaction, vinegar, sauces, mouthwash, perfumes, and some cough medicines contain alcohol.
- Liver inflammation, rare but reported. Liver function should be monitored.
- Nerve problems with long-term use
Who should not take it
Important warnings before starting
Tell your doctor about all your medical conditions, allergies, and other medicines before starting Disulfiram.
- Current alcohol use. The patient must be abstinent for at least 24 hours before the first dose
- Severe heart disease or recent stroke
- Psychosis
- Severe liver disease
Special care needed
Situations that need extra attention
- Full informed consent is essential. The patient must understand what will happen if they drink
- Alcohol must be avoided in all forms, drinks, food cooked in wine, mouthwash, hand sanitiser on broken skin, and some medicines
- Carry an information card explaining that you are taking disulfiram
- Never given to someone without their knowledge or consent
- Liver function reviewed before starting and during treatment
Pregnancy
Limited data. The safety of disulfiram in pregnancy is not well established. Specialist guidance is required.
Breastfeeding
Insufficient safety data. Specialist review required.
Other medicines
Medicines and substances that can interact with it
Always tell your doctor and pharmacist about every medicine, supplement, and herbal remedy you take, including those bought without a prescription.
- Warfarin: Disulfiram increases the effect of warfarin, raising bleeding risk. Close monitoring is required.
- Metronidazole (a common antibiotic): A severe reaction similar to the alcohol reaction can occur. This combination must be avoided.
- Any alcohol-containing medicines or preparations: Will trigger the disulfiram reaction. Every medicine must be checked for alcohol content before use.
Tests and follow-up
What your doctor will monitor
- Liver function tests at baseline, at two weeks, and periodically thereafter
- Regular counselling and psychosocial support sessions
- Assessment of motivation and treatment engagement at every appointment
Stopping this medicine
What happens if you stop taking it?
Disulfiram can be stopped gradually, but alcohol must still be avoided for at least a week after the last dose. Stopping without a plan for ongoing alcohol use disorder management significantly increases relapse risk.
In Kenya
What you should know about this medicine in Kenya
Alcohol use disorder is a significant and growing public health problem in Kenya. Disulfiram provides an additional pharmacological option for people who are fully committed to abstinence.
The principle of informed consent is particularly important with disulfiram. It should never be administered covertly, a practice that is ethically unacceptable.
Disulfiram works best within a structured programme that actively involves the family and community, and that addresses the social factors driving alcohol use.
Sources
References
- Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
- Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
- World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.
- Skinner, M. D., et al. (2014). Disulfiram efficacy in the treatment of alcohol dependence. PLOS One, 9(2), e87366.