How effective is the standard dose of disulfiram? A review of the alcohol-disulfiram reaction in practice.

The current maximum recommended dose of disulfiram, 200 mg daily, is often inadequate. Of 63 patients taking disulfiram under supervision who either risked drinking alcohol or who had a medically supervised challenge with alcohol, only half produced a significant response on a dose of 200-300 mg daily. Some patients need as much as 1.5 g daily but even at high dosage significant side effects are uncommon, reversible and rarely serious. A modification to the recommended technique for a medically supervised alcohol challenge is described, which minimises distress.