Disulfiram (Antabuse)
Irreversible aldehyde dehydrogenase (ALDH) inhibitor used as an aversive therapy for alcohol use disorder. Blocks the second step of ethanol metabolism — conversion of acetaldehyde to acetic acid — causing severe acetaldehyde accumulation when ethanol is consumed (disulfiram-ethanol reaction: flushing, nausea, vomiting, tachycardia, hypotension). Very slow elimination (t1/2 60-120 h) due to irreversible binding and long enzyme recovery time (~14 days).
Projected serum levels — 250 mg, once daily
Maintenance schedule: 250 mg once daily (oral).
Loading schedule: 750 mg on day 1, then 250 mg once daily — reaching therapeutic levels sooner.
Modeled steady state after ~11 days: peak ≈ 1.2k mg, trough ≈ 1.0k mg body load. Population-based estimate over 30 days for a 250 mg dose at a 70 kg reference body mass — the interactive app scales curves to your doses, timing, and body mass.
Key facts
- Category
- Alcohol Deterrent
- Route modeled
- Oral
- Model confidence
- inferred
- Half-life
- 3.8 days
- Common dose
- 250 mg
- Suggested maximum
- 500 mg/day
- Reference dose range
- 125–500 mg (single dose)
- Suggested cadence
- once daily
- Validated against
- 250 mg oral — Cmax 0.30 mg/L at 8 h
Documented interactions
-
contraindicated
Efavirenz (Sustiva) + Disulfiram (Antabuse)
Efavirenz (Sustiva) inducer of CYP3A4 predicted to change Disulfiram (Antabuse) AUC by ~0.16x
-
contraindicated
Rifampin + Disulfiram (Antabuse)
Rifampin inducer of CYP3A4 predicted to change Disulfiram (Antabuse) AUC by ~0.16x
-
danger
Amlodipine (Norvasc) + Disulfiram (Antabuse)
Amlodipine (Norvasc) reversible_inhibitor of CYP3A4 predicted to change Disulfiram (Antabuse) AUC by ~2.11x
-
danger
Ashwagandha (KSM-66) + Disulfiram (Antabuse)
Ashwagandha (KSM-66) reversible_inhibitor of CYP3A4 predicted to change Disulfiram (Antabuse) AUC by ~2.11x
-
danger
Berberine + Disulfiram (Antabuse)
Berberine reversible_inhibitor of CYP3A4 predicted to change Disulfiram (Antabuse) AUC by ~2.11x
-
danger
Black Seed Oil (Nigella sativa / Thymoquinone) + Disulfiram (Antabuse)
Black Seed Oil (Nigella sativa / Thymoquinone) reversible_inhibitor of CYP3A4 predicted to change Disulfiram (Antabuse) AUC by ~2.11x
Serum checks 206 modeled interaction pairings for disulfiram (antabuse) across your whole stack — absorption conflicts, enzyme inhibition, and nutrient depletion included.
Research behind this entry
-
Disulfiram treatment of alcoholism: a Veterans Administration cooperative study
Landmark 605-patient RCT showing disulfiram did not improve total abstinence but significantly reduced drinking days in patients who did drink, establishing that disulfiram's efficacy depends on medication compliance…
-
The status of disulfiram: half of a century later
Comprehensive review documenting disulfiram's continued role in alcoholism treatment with emphasis on supervised administration, the pharmacology of the disulfiram-ethanol reaction, CYP2E1 inhibition DDIs, and emerging…
-
The disulfiram-ethanol reaction: a review
Detailed characterization of the disulfiram-ethanol reaction pathophysiology — acetaldehyde accumulation (5-10x normal) produces cutaneous flushing, tachycardia, hypotension, nausea, and vomiting with severity…
3 published studies referenced in the app, each with a plain-language summary.