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Who Answers?Some people with alcohol use disorder (AUD) may need medication to stop drinking or maintain sustainable sobriety. Disulfiram, commonly sold under the brand name Antabuse, is a medication used to treat severe cases of AUD.2
In this article:
- What is Disulfiram?
- How Does Antabuse Work to Treat Alcohol Addiction?
- Who is a Candidate for Antabuse Treatment?
- What are the Side Effects of Disulfiram?
- Where Can I Receive Antabuse Treatment?
- What Precautions Should I Take while Receiving Disulfiram?
- Seeking Treatment for Alcohol Addiction
What is Disulfiram?
Disulfiram (Antabuse) is a prescription medication your doctor may prescribe to help you in recovery from AUD. It discourages alcohol consumption by causing unwanted effects after alcohol enters the body.2 It has been approved by the Food and Drug Administration (FDA) and used as a medication to help people stop drinking since 1951.3
Antabuse comes in tablet form and is taken by mouth, typically once daily. Always take the medication exactly as directed. If you cannot swallow the tablets, you may choose to crush them and mix them with water, juice, or other nonalcoholic beverages.2
How Does Antabuse Work to Treat Alcohol Addiction?
Disulfiram does not reduce cravings for alcohol but rather works to deter you from drinking. It works by disrupting the metabolism of alcohol and causing unpleasant effects when alcohol is consumed. The effects will begin about 10 minutes after consuming alcohol and may last for an hour or longer. The effects can vary but are generally proportionate to the amount of alcohol consumed. Some unpleasant effects you may experience include: 2-5
- Nausea and vomiting
- Headache
- Flushing of the face
- Blurred vision
- Weakness
- Chest pain
- Heart palpitations
- Sweating
- Impotence
- Mental confusion
- Anxiety
- Breathing difficulty
- Choking
Disulfiram helps you maintain sobriety by making you feel ill if you decide to drink. Unlike other FDA-approved medications to stop drinking, Antabuse does not directly affect opioid, glutamate, or gamma-aminobutyric receptors in the brain. Instead, it blocks dopamine-beta-hydroxylase, increasing dopamine levels and reducing noradrenaline levels. The unpleasant reaction that occurs when a person drinks alcohol after taking Antabuse is caused by a blockade of an enzyme called aldehyde dehydrogenase, which causes an accumulation of acetaldehyde in the body.3
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Help is standing by 24 hours a day, 7 days a week.Who Answers?Who is a Candidate for Antabuse Treatment?
To be a candidate for Antabuse treatment, you must have a history of alcohol dependence and have already completed the alcohol detox process. Candidates must be committed to remaining abstinent and be willing to take the medication under the supervision of a medical professional or trusted and supportive family member.3
According to the American Psychological Association guidelines, disulfiram should not be selected as an initial treatment for AUD due to the physiological effects that occur when alcohol is consumed while taking the medication. Instead, physicians are recommended to prescribe naltrexone or acamprosate as the first line of treatment.
The following people should not take Antabuse:3
- Those who are still actively drinking and unable to maintain abstinence or complete the detox process
- People who are pregnant, breastfeeding, or trying to become pregnant
- Those with severe myocardial disease or coronary occlusion
- People who experience psychosis, high levels of impulsivity, or who have a history of suicidal thoughts or attempts
- People with a hypersensitivity to disulfiram
- Patients currently taking paraldehyde, metronidazole, or alcohol-containing medications
Disulfiram should be used with extreme caution in patients over the age of 60 and those with the following conditions:3
- Hypothyroidism
- Epilepsy
- Cerebral damage
- Heart disease
- Diabetes
- Acute hepatitis or other hepatic diseases
- Acute or chronic nephritis
What are the Side Effects of Disulfiram?
Disulfiram has many potential side effects. While these side effects are common, you should speak with your doctor if any of the following symptoms are severe or persistent:2-5
- Mild headache
- Acne
- Skin rash
- Metallic or garlic-like taste in mouth
- Drowsiness
- Impotence
Other side effects may be a sign of a more severe reaction. If you experience any of these symptoms, contact your doctor immediately:2-4
- Visual disturbances
- Numbness or tingling sensations
- Lack of energy
- Appetite loss
- Upset stomach
- Weakness
- Excessive tiredness
- Yellowing of the eyes
- Dark urine
- Nausea and vomiting
While it is rare, severe and occasionally fatal cases of hepatitis associated with Antabuse may develop after a few months of treatment. Hepatitis has occurred in people with and without a history of liver problems. Your treatment team will take regular blood work to monitor your liver function to help decrease the risks of hepatitis.3
Other rare but serious conditions associated with Antabuse treatment include:3
- Optic neuritis, peripheral neuritis, or polyneuritis
- Peripheral neuropathy
Where Can I Receive Antabuse Treatment?
Disulfiram is a tablet medication that needs to be taken daily, usually under supervision. It is typically given in doses ranging from 125-500 mg. In some situations, it may be prescribed as a take-home medication, where you would be responsible for taking the drug daily on your own to help deter you from drinking. However, some studies have shown that supervision increases medication adherence and is an important component of treatment success.3
Patients may be required to go to an outpatient treatment center daily to receive their dose of disulfiram. In some cases, family members may also be trusted to dispense the medication. Court-ordered Antabuse therapy has shown greater levels of success due to enforcing the medication regimen. Medication adherence can also be improved through the use of:3
- Patient contracts
- Incentives
- Family support
- Peer support
- Regular reminders
- Behavioral counseling
There is no specific length of treatment that has proven optimal for every person. However, some evidence suggests that treatment should continue for at least six months to a year. Disulfiram may also be an appropriate short-term therapy for people who know they will be in situations where they may be triggered to use alcohol, such as attending a social event where alcohol is present or being around a family member or friend who drinks excessively.3
What Precautions Should I Take while Receiving Disulfiram?
If you are taking any other medications or have any underlying physical or mental health conditions, talk to your doctor thoroughly about each of these before taking Antabuse.
If you miss a dose, take the medication as soon as you remember it. However, if it is too close to your next dose, skip it. Do not take a double dose to make up for a missed pill.2
Always keep all appointments with your doctor and laboratory. Lab work may be done to help your doctor check how you are responding to the Antabuse medication and to monitor your liver function. 2,3
Always carry a medical alert card on you that explains you are taking disulfiram and includes possible adverse effects that could occur.3
You should not drink any alcohol while taking disulfiram, nor within 12 hours before the first dose or for several weeks after taking the medication. This includes beer, wine, cough syrups, and even sauces, foods, and vinegars that contain alcohol. You also should avoid coming into contact with or breathing paint fumes, paint thinner, or other products containing alcohol.2
Psychosis, which can be characterized by erratic behavior or a difference in perceived reality, has been reported as a side effect of disulfiram; monitor your mental health closely and talk to a doctor if you experience any unusual mental health symptoms.3
Reactions to alcohol when taking disulfiram can range in intensity, duration, and severity. Severe reactions may require palliative and supportive medical care to treat symptoms of shock and restore normal blood pressure.3
Seeking Treatment for Alcohol Addiction
If you or someone you love is struggling with alcohol use disorder and would like to try medication to stop drinking, call
800-948-8417
Who Answers?
to speak with an addiction treatment specialist about FDA-approved medications as well as other available treatment options.
Resources
- National Institute on Alcohol Abuse and Alcoholism. (April 2021). Understanding Alcohol Use Disorder.
- S. National Library of Medicine. (August 2017). Disulfiram.
- Substance Abuse and Mental Health Services Administration. (2015). Medication for the Treatment of Alcohol Use Disorder: A Brief Guide.
- Winslow, B., Onysko, M., & Hebert, M. (March 2016). Medications for Alcohol Use Disorder. American Family Physician, 93(6): 457-65.
- Mason, B. & Heyser, C. (June 2021). Alcohol Use Disorder: The Role of Medication in Recovery. Alcohol Research Current Reviews, 41(1):7