Disulfiram (Antabuse®)

What Is Disulfiram?

Disulfiram is an FDA-approved drug used to treat chronic alcohol dependence and alcohol use disorder. The drug is also known by the brand name Antabuse®.

The use of disulfiram during treatment brought abstinence rates to more than 50%, especially when used for at least an average of 20 months.

Although disulfiram does not treat the cravings many alcoholics experience, the risk of distressing symptoms can help patients make better decisions during recovery.

Drinking alcohol while taking disulfiram can cause headaches, nausea, and vomiting. These uncomfortable symptoms,m  work as effective deterrents against drinking alcohol while taking disulfiram.

How Does Disulfiram Treat Alcohol Addiction?

Disulfiram is only available through prescription and is typically prescribed as part of an individual’s alcohol addiction treatment plan. Disulfiram is usually only used for patients who are serious about their sobriety and are willing to risk negative symptoms to achieve recovery.

While disulfiram can be life-changing for recovering alcoholics, there are some risks associated with the medication that should be considered.

Always ensure you take disulfiram as directed and be aware of the foods or products that may trigger unpleasant symptoms while taking the drug.

How Disulfiram Works

When alcohol enters the body, the body breaks it down into the chemical acetaldehyde and then converts it into acetic acid. Disulfiram is an inhibitor that disrupts this process by blocking the enzyme involved in the conversion from acetaldehyde to acetic acid.

If an individual drinks while taking disulfiram, the acetaldehyde levels rise sharply and cause very unpleasant symptoms. These symptoms are caused by the disulfiram-alcohol reaction or disulfiram-ethanol reaction (DER).

How Is Disulfiram Used?

Disulfiram should only be prescribed after the patient completes their initial withdrawal and detox period. The average initial dose of disulfiram is around 250 mg, with maintenance dosages being anywhere between 125mg and 500mg.

Patients must abstain from alcohol for at least 12 hours and have a blood alcohol level of 0 before taking their first dose.

Ensuring that no amount of alcohol is in your system prevents the disulfiram-ethanol reaction (DER); symptoms of DER can arise within 10 to 30 minutes after ingestion of disulfiram.

How Does Disulfiram Compare to Other Medications for Alcoholism?

Disulfiram is one of several MATs or medication-assisted treatments designed to help patients recover from addiction. MATs are currently used in the treatment of alcohol use disorders and opioid use disorders.

The FDA has approved the following drugs to treat alcohol abuse:

• Acamprosate (Campral®)
• Disulfiram (Antabuse®)
• Naltrexone (Vivitrol®, Revia®)

Acamprosate is commonly prescribed alongside disulfiram, as some studies indicate that the combination can make disulfiram more effective. Unlike disulfiram, acamprosate works by helping to normalize brain activity that the cessation of alcohol use has disrupted.

Naltrexone, on the other hand, has been effectively used for alcohol use disorder and opioid use disorder by binding to specific brain receptors and blocking the euphoric effects of either substance.

Possible Side Effects of Disulfiram Treatment

Although disulfiram has been successfully and safely used to treat alcoholism since 1951, there are risks to taking the drug. Your doctor will explain the possible serious side effects before prescribing the medication.

The severity of symptoms caused by disulfiram-ethanol reaction (DER) will depend on the level of alcohol consumption. The more alcohol the patient drinks, the more intense DER symptoms will become.

Common adverse effects of DER that occur when drinking alcohol on disulfiram include:

• Heart palpitations and fast heartbeat (tachycardia)
• Low blood pressure (hypotension)
• Chest pain
• Sweating
• Flushing
• Nausea
• Vomiting
• Dizziness or drowsiness
• Fainting
• Confusion

Serious adverse reactions are less common but may include:

• Reactions with other medications
• Hypersensitivity to the disulfiram
• Skin rash
• Decrease in libido
• Optic neuritis or swelling around the optic nerve that causes pain during eye movement or temporary blindness in one eye
• Neuropathy (weakness, numbness, and pain from nerve damage, usually in the hands and feet)
• Liver toxicity and liver disease
• Hepatitis
• Psychosis
• Delirium

If any of these severe reactions occur, seek immediate medical attention, as some of these conditions are medical emergencies.

What to Know Before Starting Disulfiram Treatment

Make sure you inform your doctor of all medical conditions and medications you take so they can ensure no adverse interactions occur while taking disulfiram. Your doctor will also advise you of foods, drinks, and products that could trigger unpleasant DER symptoms.

Disulfiram may also interfere with certain lab tests, particularly urine VMA/HVA tests. Make sure you disclose your disulfiram prescription when getting lab work done. Disulfiram may also intensify the effects of caffeine, so be cautious of caffeine intake while taking the drug.

Medications that may cause serious drug interactions with disulfiram include:

• Blood thinners like warfarin
• Amitriptyline
• Benznidazole
• Medications for seizures, including hydantoins such as phenytoin/fosphenytoin
• Fezolinetant
• Isoniazid
• Metronidazole
• Theophylline
• Tinidazole

Patients also need to be cautious about certain foods or products containing alcohol. Foods or alcohol-containing products to be wary of include:

• Mouthwashes with alcohol
• Aftershaves with alcohol
• Cough syrups
• Cooking wine or vinegar
• Extremely ripe fruits
• Certain desserts
• Fumes from paint thinner, varnish, paint, or shellac

Get Treatment for Alcohol Addiction with Disulfiram

If you or a loved one is ready to seek sobriety from alcohol use disorder but struggles with relapse, ask your healthcare provider if disulfiram might be a good option for you. Although disulfiram comes with certain risks, patients prescribed the drug have better rates of recovery and abstinence.

For individuals without a doctor or who don’t know where to start, try SAMHSA’s online treatment locator or call 1-800-662-4357. These resources can help you find treatment programs and doctors in your area who specialize in alcohol and substance use disorder treatment options.