Esperal
✅ Treats Alcohol Dependence
✅ Reduces Craving Urges
✅ Promotes Sobriety Maintenance
✅ Supports Recovery Process
✅ Enhances Life Quality
✓ Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring · Laatst beoordeeld: mei 2026
⚡ Quick Answer — Esperal — disulfiram 250 mg for alcohol use disorder
Esperal is disulfiram 250 mg — the standard maintenance strength. It blocks aldehyde dehydrogenase, so any alcohol consumed produces acetaldehyde build-up and the unpleasant disulfiram–ethanol reaction (flushing, nausea, palpitations, hypotension). It works by deterrence, not craving reduction. You must be alcohol-free for at least 12 hours before the first dose. Best paired with supervised dosing and behavioural support.
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What is Esperal?
Esperal is an alcohol-aversion medication containing disulfiram 250 mg (tablets), supplied by WHO-GMP certified manufacturer. It is the oldest licensed pharmacotherapy for alcohol use disorder (in clinical use since 1949) and remains useful as an adjunct in motivated patients with structured supervision — it does not reduce craving directly, but the credible threat of an unpleasant reaction acts as a robust behavioural deterrent.
How disulfiram works
Alcohol metabolism is a two-step process: ethanol → acetaldehyde (via alcohol dehydrogenase) → acetate (via aldehyde dehydrogenase, ALDH). Disulfiram irreversibly inhibits ALDH, so even small amounts of ethanol cause acetaldehyde to accumulate to many times normal levels. Acetaldehyde is responsible for the toxic component of a hangover; at sustained high levels it produces the disulfiram–ethanol reaction (DER): facial flushing, throbbing headache, nausea, vomiting, palpitations, dyspnoea, sweating, hypotension. Severe reactions can include arrhythmia, MI, seizures, coma. The intensity is roughly proportional to the alcohol dose — even a glass of wine usually triggers a moderate reaction.
Because ALDH inhibition is covalent, it persists for up to 14 days after the last disulfiram dose. The DER can still be triggered up to two weeks after stopping the drug.
How Esperal is used
The 250 mg strength of Esperal is the standard maintenance formulation:
| Fase | Daily dose | Duur |
|---|---|---|
| Loading (consider 500 mg formulation) | 500 mg once daily | 1–2 weeks (optional) |
| Maintenance (with 250 mg Esperal) | 125–250 mg once daily | Typically 6–12 months, occasionally longer |
One 250 mg tablet daily is the most common maintenance dose. If side effects appear or sedation is troublesome, dose can be split (a half-tablet morning + half-tablet evening) or reduced to 125 mg (half-tablet) once daily. Some patients require a 500 mg maintenance dose to maintain a clinically meaningful DER on alcohol exposure — this is a prescriber decision based on observed reaction strength.
Take in the morning with water; an evening dose is acceptable if morning drowsiness is a problem. Supervised dosing (a partner, family member, or pharmacist watches the dose go down) substantially raises adherence and is a cornerstone of disulfiram’s evidence base.
Side effects (independent of alcohol)
Even without an alcohol reaction, disulfiram has its own adverse-effect profile:
- Drowsiness, fatigue in the first 1–2 weeks (most common; usually settles)
- Metallic or garlic-like aftertaste — characteristic and often persistent
- Headache, dizziness, dermatitis
- Reduced libido, erectile difficulty (uncommon)
- Hepatotoxicity (rare but serious) — idiosyncratic hepatitis, sometimes fatal. Baseline LFTs, repeat at 2 weeks, then monthly for the first 3 months, then 3-monthly. Stop immediately if jaundice, dark urine, RUQ pain, or marked transaminase rise.
- Peripheral neuropathy and rarely optic neuritis at higher doses or longer courses — report numbness, tingling, or visual changes
- Disulfiram-induced psychosis — rare; usually associated with very high doses or pre-existing schizophrenia
Geneesmiddelinteracties
| Geneesmiddel / klasse | Effect / risk | Action |
|---|---|---|
| Metronidazole, tinidazole | Confusion, psychosis — potentiated CNS toxicity | Avoid combination |
| Isoniazid | Ataxia, irritability, psychosis | Avoid; if essential, monitor closely and use lowest effective dose |
| Warfarine | INR rises (CYP2C9 inhibition); bleeding risk | Reduce warfarin dose; monitor INR weekly initially |
| Fenytoïne | Phenytoin level rises (CYP2C9/2C19 inhibition); toxicity | Reduce phenytoin dose; monitor levels |
| Theofylline | Theophylline level rises | Monitor or use alternative bronchodilator |
| Benzodiazepines (CYP-metabolised: diazepam, alprazolam, midazolam) | Sedation potentiated | Use lorazepam or oxazepam (non-CYP) if sedative needed |
| Tricyclic antidepressants | Acute organic brain syndrome reports | Voorzichtig gebruiken |
| Amitriptyline | May enhance DER intensity | Use cautiously |
| Cannabis | Hypomania reports | Counsel patient |
| Levodopa | Reduced effect | Monitor Parkinsonian control |
Contra-indicaties
- Severe coronary artery disease, recent MI, serious arrhythmia — the cardiovascular component of the DER may be dangerous
- Active psychosis or severe personality disorder where reaction-induced distress could be destabilising
- Pregnancy — teratogenic concerns; avoid
- Ernstige leverfunctiestoornis
- Active alcohol intoxication (the 12-hour rule above)
- Recent metronidazole, isoniazid, or paraldehyde use
- Hypersensitivity to thiuram derivatives (rubber industry workers may be sensitised)
Where disulfiram fits
Disulfiram works best as a structured deterrent for highly motivated patients with abstinence (not reduction) as their goal, ideally with a partner or family member who supervises each daily dose. It does not act on craving or reward circuits, so it pairs well with naltrexone (which dampens reward) or acamprosate (which reduces post-cessation craving) in tougher cases. It is not first-line in modern guidelines — naltrexone and acamprosate are usually preferred — but it remains the most effective option for the right patient profile, particularly where craving-reduction agents have failed.
Opslag
Store at room temperature (15–30 °C / 59–86 °F), in the original blister, away from direct light and moisture. Keep out of reach of children — accidental ingestion in a child can produce a severe reaction.
Veelgestelde vragen
How long after stopping disulfiram is it safe to drink?
ALDH inhibition is irreversible — the body must synthesise new enzyme to recover function. Avoid all alcohol for at least 14 days after the last disulfiram dose. Some sensitive patients describe mild reactions up to three weeks later.
Will I have a reaction from cooking with wine?
Most cooked alcohol is largely volatilised and a brief simmer will not usually trigger a reaction, but a flambe, a sauce reduced for only a few minutes, or a tiramisu can. The safest position is to avoid alcohol-containing recipes entirely while on therapy.
Can I drink non-alcoholic beer?
Many “0.0%” alcohol-free beers contain trace ethanol (0.05–0.5%). Some patients on disulfiram have reactions to several bottles in one session. Truly alcohol-free brands (genuine 0.0%) are usually safe but read the label carefully.
Why does my mouth taste metallic?
Disulfiram is metabolised to carbon disulfide, which is excreted partly through the breath and saliva — this produces a characteristic metallic or garlic taste. It is harmless and most people adapt.
Is it safe with my heart medication?
Most antihypertensives are compatible. The chief concern is the cardiovascular load of a disulfiram–ethanol reaction itself in patients with serious coronary or cerebrovascular disease — not the daily medication interaction. Disclose your full cardiac history before starting.
How is it different from naltrexone?
Naltrexone works on opioid receptors to reduce the reward of drinking — it does not produce a reaction. Disulfiram has no effect on craving but produces a strong aversive reaction if alcohol is consumed. They can be combined in some patients.
Do I need supervised dosing?
Strongly recommended — supervised disulfiram has the strongest evidence base. Adherence is the single biggest determinant of effectiveness; an unsupervised patient who quietly stops the drug a few days before drinking gets no protection. A partner or pharmacist watching the dose go down each day raises 6-month abstinence rates substantially.
What if I have a reaction by accident?
Mild reactions (flushing, mild nausea, headache) usually resolve in 1–2 hours with rest and oral fluids. A severe reaction (hypotension, severe vomiting, chest pain, dyspnoea, fainting) is a medical emergency — call emergency services. Do not “wait it out”.
Does it work for opioid dependence?
No. Disulfiram is specific to alcohol metabolism. For opioid use disorder, naltrexone, buprenorphine, and methadone are the licensed options.
How long should I stay on it?
6–12 months is typical. Longer courses are used in some patients, particularly with high-stress relapse risk. Stopping is a planned decision with the prescriber based on stable abstinence, behavioural-support engagement, and life-circumstance review.
Other Alcohol & Drug Treatment Medications
- Naltima (naltrexone 50 mg) — opioid-receptor antagonist; reduces alcohol reward and craving — first-line alternative or combination partner.
- Acamprol 333 mg (acamprosate) — NMDA modulator for maintaining abstinence after cessation; pairs well with disulfiram in tougher cases.
- Topamac (topiramate 25/50 mg) — off-label adjunct for alcohol use disorder, useful particularly in those with comorbid migraine or epilepsy.
- Esperal (disulfiram 250 mg) — alternative disulfiram brand from a different manufacturer at the standard maintenance strength.
- Champix (varenicline 1 mg) — smoking-cessation aid — many patients with alcohol use disorder also smoke heavily, and addressing both improves outcomes.
More options in Alcohol and Drug Treatment
Gerangschikt op recente bestelvolumes van MedsBase — wat andere klanten in deze categorie kiezen.
| Sterkte | 250 mg |
|---|---|
| Hoeveelheid | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s |
| Farmaceutische vorm | Tablet/s |
| Fabrikant | Torrent Pharma |
| Behandeling | Alcohol Dependence |
| Generiek merk | Disulfiram |
Esperal
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