Approved in 1951 as the first US FDA-authorized medication for AUD, disulfiram irreversibly inhibits ALDH1 and ALDH2. The resulting acetaldehyde buildup provokes an aversive reaction (flushing, nausea, tachycardia) whenever alcohol is consumed. Although effective with supervised dosing, it is no longer first-line therapy due to poor adherence, variable efficacy, and hepatotoxicity concerns (168, 296).
