Which medication is known for its potential high rates of non-compliance due to side effects?

Disulfiram is known for potentially high rates of non-compliance primarily due to its side effects and the aversive reaction it can provoke when alcohol is consumed. Disulfiram works by blocking the enzyme aldehyde dehydrogenase, leading to an accumulation of acetaldehyde when alcohol is ingested, causing unpleasant effects such as flushing, nausea, and palpitations. This unpleasant experience can deter individuals from following the treatment plan, especially if there is any chance they might consume alcohol.

Patients may also find it difficult to integrate into their lifestyle due to the need for strict adherence to abstaining from alcohol. The combination of the distressing physical reactions and the strict adherence required can lead to high dropout rates from the treatment. Conversely, other medications used for managing alcohol dependency, like naltrexone and acamprosate, tend to have fewer adverse effects that impact compliance, making disulfiram stand out in this regard. Therefore, the nature of disulfiram's action and its side effects greatly contribute to non-compliance among patients.