Esperal - Use | Dose | Side Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on Thu, 27 Dec 2018. To read more about an author, click here.

Esperal is a medicine that contains the active substance called disulfiram. It works by inhibiting an enzyme called acetaldehyde dehydrogenase. This enzyme is involved in alcohol metabolism. Alcohol is first metabolized into acetaldehyde (a very toxic substance) via enzyme alcohol dehydrogenase, which is then further converted into acetic acid (which is easily eliminated from the body) via enzyme acetaldehyde dehydrogenase.

By blocking the enzyme acetaldehyde dehydrogenase, Esperal blocks converting of acetaldehyde to acetic acid, which causes raised concentrations of acetaldehyde and this result in following unpleasant symptoms:

  • nausea,
  • vomiting,
  • fatigue,
  • redness,
  • low blood pressure and rapid heartbeat (tachycardia).

Therefore, this medicine is used for alcohol relapse prevention. Therefore, ingestion of even small quantities of alcohol may produce unpleasant symptoms listed above, and thus discourages drinking. Unpleasant symptoms begin only 10 minutes after alcohol enters the body and lasts for several hours.

This drug is approved by the FDA (US Food and Drug Administration) and it is available in the United States for more than half a century.

This medicine is effective and well tolerated when used for alcohol relapse prevention.1,2

However, some authors believe that this medicine should not be used over a longer period of time and it is necessary to constantly monitor the patient in order to achieve maximum therapeutic effect.3


Esperal should be avoided in the following conditions:

  • In patients who are allergic to the active substance disulfiram or other similar medicines.
  • In patients with hepatic impairment (liver damage). This medicine may cause hepatitis, which is sometimes fatal.4 This side effect occurs very rarely. However, you should be aware of the liver damage symptoms, including:
    • pain in the right upper abdomen,
    • nausea,
    • vomiting,
    • loss of appetite and jaundice. If you are experiencing any of these symptoms, contact your doctor immediately.
  • In patients with neuropsychiatric disorders. This medicine can lead to the appearance of psychosis in patients with psychosis susceptibility and may lead to complications in patients with mental illnesses.4
  • In patients with cardiovascular disease.
  • In patients with renal impairment.
  • Patients with diabetes.
  • In patients with difficulty breathing.

This medicine should be used with your doctor advice.

Use of Esperal during pregnancy and breastfeeding

Esperal should be avoided during pregnancy due to insufficient data regarding the safety of its using during pregnancy.

Avoid breastfeeding while using this medicine.

How to use

The usual dose is 500 mg (one Esperal tablet) once a day, in the morning during breakfast.

Swallow the tablet whole with a glass of water.

Avoid using alcohol because you will experience unpleasant symptoms listed above. Be careful when you are applying aftershave (as they often contain alcohol) as well if you are using some foods that may contain alcohol (e.g. rum cakes).

Note: Wait at least 24 hours after drinking before you start taking this medicine.

Use with other medicines (Interactions)

Esperal should be avoided in combination with the following medicines:

  • Metronidazole, medicine used in the treatment of infections. Concomitant use of Esperal with this medicine can lead to the appearance of psychosis which is short-term.
  • Phenytoin, medicine used to treat epilepsy. Concomitant use of Esperal with this medicine increases concentration of phenytoin in the blood and may lead to side effects.
  • Isoniazid, medicine used to treat tuberculosis. Concomitant use of Esperal with this medicine can lead to the appearance of behavioral disorders.
  • Anticoagulant medicines, such as: warfarin.
  • Medicines used in the treatment of HIV infection (AIDS), such as:
    • efavirenz,
    • ritonavir,
    • atazanavir and others.5

Tell your doctor about all medications and herbal products you are taking.

Side effects

Esperal can cause following side effects:

  1. nausea,
  2. vomiting,
  3. diarrhea,
  4. impaired taste,
  5. headache,
  6. hepatitis (pain in the right upper abdomen, loss of appetite, jaundice, nausea),
  7. neurological disorders,
  8. sleepiness,
  9. fatigue,
  10. anxiety,
  11. allergy and others.

Tell your doctor if you are experiencing any side effects.


  1. Niederhofer H, Staffen W. Comparasion of disulfiram and placebo in treatment of alcohol dependence of adoloscents. Drug Alcohol Rev. 2003: 22(3): 295-7.
  2. Skinner DM, Lahmek P, Pham H, Aubin HJ. Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta Analysis. PLoS One. 2014: 9(2): e87366.
  3. Banys P. The clinical use of disulfiram (Antabuse): a review. J Psychoactive Drugs. 1988: 20(3): 243-61.
  4. Chick J. Safety issues concerning the use of disulfiram in treating alcohol dependence. Drug Saf. 1999: 20(5): 427-35.
  5. McCance Kats EF, Gruber VA, Beattz G, and others. Interactions of disulfiram with antiretroviral medications: efavirenz increases while atazanavir decreases dislufiram effect on enzymes of alcohol metabolism. Am J Addict. 2014: 23(2): 137-44.

Information on this website are provided for educational purposes only and are not intended for medical advice, diagnosis or treatment.

If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.