Disulfiram (Antabuse) guideline includes which precaution?

• A. Must be alcohol-free 12 hours; avoid substances for 2 weeks after stopping
• B. Can be taken with alcohol
• C. Safe in pregnancy
• D. No monitoring required

Answer: (A)

Disulfiram works by blocking aldehyde dehydrogenase, so when any alcohol is ingested, acetaldehyde builds up and causes unpleasant symptoms (flushing, tachycardia, nausea, vomiting, dizziness). Because even small amounts of alcohol can trigger this reaction, a key precaution is that a patient must be alcohol-free before starting and must avoid all sources of alcohol during treatment, including hidden sources like mouthwash, cough syrups, and certain flavorings. The guideline specifies staying alcohol-free for at least 12 hours before the first dose and avoiding alcohol-containing products for about 2 weeks after stopping to allow enzyme activity to recover. This safeguards against a disulfiram-ethanol reaction if alcohol is encountered. It’s not safe in pregnancy, and ongoing monitoring is important to watch for hepatotoxicity and adherence, which is why the other statements don’t fit.