Disulfiram, first approved for treating AUD in 1949, inhibits aldehyde dehydrogenase, which metabolizes acetaldehyde, a toxic metabolite of alcohol. Inhibiting the enzyme rapidly increases the concentration of acetaldehyde and produces a disulfiram-ethanol reaction (DER) characterized by nausea, flushing, vomiting, sweating, hypotension, palpitations, and rarely, serious reactions including cardiovascular collapse. Although these effects are well recognized, their frequency is not documented in the literature. The presumed effectiveness of disulfiram is based on the patient’s fear of these adverse effects, not a direct pharmacologic action.
