Disulfiram is an aversion medication therapy that blocks the breakdown of alcohol in the liver resulting in a buildup of acetaldehyde and a toxic reaction 5–30 minutes after drinking alcohol. The “disulfiram-alcohol reaction” includes nausea, vomiting, facial flushing, headache, dizziness, sweating, heart palpitations, and blurred vision; it lasts 30 minutes to a few hours after alcohol use stops. Alcohol and alcohol-containing products should be avoided (e.g., mouthwash, cold medications) while taking and up to two weeks after stopping disulfiram. Patients should be thoroughly educated and carry a medical alert card. Dosage is 250 mg Tablet once/day; patient must be abstinent at least 12 hours from alcohol and alcohol-containing products to begin medication. Side effects are usually minor and transient, but may include drowsiness, fatigue, metallic or garlic aftertaste, skin rash or acne, headaches, and impotence. Very rarely can cause serious liver injury; liver function should be tested prior to and regularly during treatment. A good candidate might be a highly motivated alcoholic with poor impulse control who uses despite multiple treatment episodes.
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