Question – What is the mechanism of action of disulfiram when used to treat alcohol use disorder?
Answer- The cited article notes “Disulfiram is an acetaldehyde dehydrogenase inhibitor, inhibiting the metabolism of acetaldehyde to its inert metabolite, acetic acid, when alcohol is consumed. Accumulation of acetaldehyde leads to symptoms typical of the “disulfiram reaction,” namely, flushing, headache, nausea and vomiting, diaphoresis, and lightheadedness. In severe cases, the disulfiram reaction can also lead to hemodynamic instability, so it is essential that patients understand the consequences of drinking alcohol while taking disulfiram. When using disulfiram as prescribed, even very small amounts of alcohol are sufficient to precipitate the disulfiram reaction.” (Holt SR and Tobin DG. Pharmacotherapy for alcohol use disorder. 2018 Med Clinics of North America 102(4): 653-666)