Antabuse (Disulfiram) Treatment for Alcohol Use Disorder

Antabuse (disulfiram) is a medicine used to treat alcohol abuse and alcohol dependence. It can be an effective deterrent because it causes an extremely unpleasant reaction if a person drinks alcohol while taking it. Antabuse was the first medicine approved by the Food and Drug Administration (FDA) to treat alcohol use disorder.

How Antabuse Works

When you consume alcohol, your body metabolizes it into acetaldehyde—a toxic substance that causes many of the hangover symptoms that occur after heavy drinking. Under normal circumstances, your body continues to oxidize acetaldehyde into acetic acid, which is harmless.

Antabuse interferes with this metabolic process by preventing the oxidation of acetaldehyde into acetic acid. This causes a build-up of acetaldehyde in the body that is five to 10 times greater than what would normally be present after drinking alcohol.

Effects of Drinking While on Antabuse

The high concentration of acetaldehyde that occurs when someone drinks while taking Antabuse triggers a very unpleasant reaction. The severity of the reaction, which can range from mild to severe, depends on how much Antabuse and alcohol are consumed. Symptoms last as long as alcohol is in the body.

Someone who drinks alcohol while taking Antabuse may experience symptoms including:

• Flushing
• Nausea
• Copious vomiting
• Sweating
• Thirst
• Throbbing in the head and neck
• Headache
• Respiratory difficulty
• Chest pain
• Palpitations
• Dyspnea (shortness of breath)
• Hyperventilation (rapid breathing)
• Tachycardia (rapid heartbeat)
• Hypotension (low blood pressure)
• Syncope (loss of consciousness)
• Marked uneasiness
• Weakness
• Vertigo
• Blurred vision
• Confusion

Severe reactions can include respiratory depression, cardiovascular collapse, myocardial infarction (heart attack), acute congestive heart failure, unconsciousness, arrhythmias, convulsions, and even death.

Antabuse Side Effects

Even if you don't drink while taking Antabuse, it is still possible to experience some side effects. Some of the most common side effects of Antabuse include:

• Acne
• Drowsiness
• Fatigue
• Headache
• Metallic aftertaste

In rare cases, taking Antabuse can result in nerve pain or damage, psychosis, and skin rash. A few patients have had an acute liver injury as a result of taking disulfiram. Case studies have also associated disulfiram use with a single seizure episode.

Who Should Not Take Antabuse

Only someone who wants to quit drinking and is fully aware of the consequences of drinking while on Antabuse should take this drug. Antabuse should never be given to someone without their knowledge and informed consent, nor should it be given to anyone who is intoxicated.

Due to possible severe reactions, Antabuse should not be used by anyone with severe heart disease, psychosis, or an allergy to Antabuse. People who are pregnant should not take Antabuse or disulfiram unless their healthcare provider feels that the benefits outweigh the risks.

Because disulfiram interactions can occur with other medications, someone taking Antabuse should also consult with their healthcare provider before taking other prescription or over-the-counter drugs.

What to Know Before Using Antabuse

If you are taking Antabuse, do not drink any alcoholic beverages, including wine and beer. Also stay away from other medications that contain alcohol while on Antabuse or disulfiram, such as cough syrup, elixirs, and some cold and flu products.

Even hand sanitizers, aftershave, rubbing alcohol, mouthwash, perfume, and hairspray can all cause a response. It's equally important that you avoid all foods and beverages containing alcohol. This includes:

• Certain flavorings
• Kombucha
• Sauces
• Vinegar

Avoiding these substances while taking Antabuse can help prevent a reaction. You can also help stop a reaction by not using these substances during the 12-hour period before you take your first dose and for several weeks after stopping the drug.

What Antabuse Doesn't Do

Antabuse serves as a physical and psychological deterrent for someone trying to stop drinking. It does not reduce the person's alcohol cravings, nor does it treat any alcohol withdrawal symptoms.

How Effective Is Antabuse?

In Europe (where Antabuse is more widely used than in the United States), research has shown that long-term use of this drug is effective in helping people stop drinking, producing abstinence rates of 50%. This research also revealed that the longer a person takes Antabuse, the more effective it is, because they develop a habit of not drinking.

Other studies have failed to show such positive results. But it's also important to keep in mind that the effectiveness of Antabuse in helping someone to quit drinking depends on continued use of medication. Because Antabuse or disulfiram is administered in a daily pill, people can simply stop taking the drug and begin drinking several weeks later.

How to Use Antabuse

Antabuse or disulfiram is generally given in tablet form. There are two dosage options: 250 milligrams or 500 milligrams. The smaller Antabuse dosage may be attempted first to make sure the drug will be well tolerated, only moving up to the higher dosage if it is.

Antabuse can be taken in the morning or evening, although evening may be best if it makes you tired. If you experience an upset stomach when taking disulfiram or Antabuse, take it with food to reduce this feeling. The tablet can also be crushed and added to water, juice, or coffee if this makes it easier to take.

If you miss taking a pill at the regular time, don't double up or take the missed dose too close to when the next one is due. Antabuse begins acting fairly quickly after taking the very first dose and can create a response up to two weeks after the medication has been stopped.

It is also recommended that people taking Antabuse carry a card with them that describes what will happen if they consume alcohol. This card should contain the name and phone number of a healthcare provider in case they need to be contacted in the event of a reaction.