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Disulfiram (Antabuse): Treatment for Alcoholism and Alcohol Abuse

What is Disulfiram?

Disulfiram (also known by the brand name Antabuse) is a medication that is used to treat chronic alcoholism. 

Disulfiram can work well for people who want to cut back on their drinking or stop drinking altogether. If someone taking the medication drinks alcohol, they’ll experience a variety of unpleasant and even dangerous physical side effects. It’s most effective for people who are committed to their sobriety. Otherwise, a person could simply stop taking the medication if they decide to start drinking alcohol again. 

Disulfiram was the first drug to be approved by the FDA for the treatment of alcohol use disorder and alcohol abuse in 1951.1 It was the most common medication used for alcoholism treatment during the 20th century. 

Today, Antabuse is typically replaced or used with newer drugs like Revia, Vivitrol (naltrexone), and Campral (acamprosate). These newer drugs work differently because they directly interact with brain chemistry.

How Does Disulfiram Work?

Unlike newer drugs (Revia, Vivitrol, Campral), which directly interact with brain chemistry to treat alcoholism, disulfiram does not do this. Instead, it discourages the consumption of alcohol by interfering with the way your body digests and absorbs alcohol. This produces very unpleasant side effects, which make you not want to drink alcohol anymore.

Disulfiram does not treat alcohol withdrawal symptoms or reduce cravings. It’s designed to be taken regularly by mouth in tablet form (250 mg or 500 mg tablets). People who use disulfiram for alcohol addiction treatment take it once per day.

Disulfiram is not available OTC and must be prescribed by a doctor. A medical doctor will also be able to determine if Antabuse is the right medication for your alcohol dependence treatment or if there is a better alternative available.

What Happens If You Drink Alcohol While Taking Disulfiram?

A disulfiram reaction with alcohol can occur if you drink while you’re taking the medication. This reaction will produce very unpleasant or dangerous side effects like:2

  • Sweating
  • Flushing of the upper chest and face
  • Hyperventilation
  • Respiratory problems
  • Bad breath
  • Blurry vision
  • Extreme thirst
  • Throbbing of the head and neck
  • Nausea
  • Vomiting
  • Chest pain/palpitations
  • Low blood pressure
  • Fast heart rate
  • Vertigo
  • Confusion
  • Weakness 

Other more severe and rare symptoms of a disulfiram reaction with alcohol can include:

  • Cardiac arrest
  • Irregular heartbeat
  • Heart attack
  • Acute congestive heart failure
  • Seizures
  • Unconsciousness
  • Death 

So, how is this disulfiram reaction caused? 

  • Normally, when you drink alcohol, an enzyme called alcohol dehydrogenase converts the alcohol into acetaldehyde in the body. Another enzyme called acetaldehyde dehydrogenase then comes along and converts acetaldehyde into acetic acid. 
  • If you’re taking disulfiram, this process looks slightly different. The medication will prevent acetaldehyde dehydrogenase from converting acetaldehyde into acetic acid. As a result, high acetaldehyde levels in your blood can cause the unpleasant symptoms listed above.

The disulfiram reaction caused by alcohol consumption typically dissuades alcoholics from drinking. Although (as mentioned above), some people bypass this by refusing to take the medication or lying about taking it.

Additionally, Antabuse can cause this type of reaction with alcohol for up to 14 days after ingesting it. Consuming any type of product that contains alcohol may produce a reaction, such as:

  • Mouthwash
  • Certain sauces
  • Fermented vinegar

Disulfiram Side Effects

If your doctor or another medical professional prescribes disulfiram for the treatment of your alcohol addiction, you might experience some side effects when you start taking it. 

Common disulfiram side effects can include:3

  • Tiredness
  • Drowsiness
  • Headache
  • Acne
  • Metallic or garlic aftertaste
  • Impotence
  • Skin rash
  • Swollen or sore tongue

Other more severe disulfiram side effects may include:3

  • Polyneuritis (progressive symmetrical temporary paralysis and loss of reflexes usually beginning in the legs)
  • Hepatitis
  • Weakness, numbness, and pain from nerve damage
  • Inflammation of the optic nerve
  • Psychotic disorder
  • Small, raised acne-like bumps on the face, scalp, chest, and upper back

These side effects should go away within a few weeks once your doctor tapers your dosage down to a maintenance level.

What Are the Symptoms of Disulfiram Withdrawal?

Disulfiram does not produce any known withdrawal symptoms.

How Long Does Disulfiram Stay In Your System?

The half-life of disulfiram is 60 to 120 hours, which is a relatively slow rate of elimination. If you take disulfiram and decide to drink alcohol again, you should wait at least two weeks for the medication to be completely eliminated from your system before you consume alcohol.

If your doctor or another medical professional has prescribed disulfiram, you should continue taking it every day until you have sustained your sobriety for an extended time. At that point, you may want to speak with your doctor about discontinuing your Antabuse use.

Is Disulfiram Safe to Use?

Disulfiram is safe to use if your doctor prescribes it for you and if you take it properly as prescribed.4 Antabuse may not be recommended for you if you have any of the following conditions:

  • A psychotic condition like schizophrenia
  • Liver damage
  • Cardiovascular disease
  • Diabetes
  • Epilepsy
  • Allergies to sulfur, nickel, or thiuram derivatives
  • Kidney disease
  • A history of traumatic brain injury

Is Antabuse Discontinued?

According to the American Society of Health-System Pharmacists, several pharmaceutical companies have discontinued disulfiram tablets, including: 

  • Teva Pharmaceuticals
  • Mylan
  • Rising Pharmaceuticals 

Currently, Alvogen is the only supplier of disulfiram tablets.5

Disulfiram for Alcohol Addiction Treatment

Disulfiram is not intended to be taken on its own. Instead, it should be used in combination with supportive addiction treatment care and psychotherapy.

Depending on the severity of your addiction and your addiction treatment history, a combination of the following treatment programs may help you overcome your alcohol addiction while you’re taking disulfiram:

  • Medical detox for alcohol addiction: Medical detox programs provide 24/7 monitoring of your vitals to ensure that you’re safely progressing through alcohol withdrawal. A team of doctors and nurses will administer medication as needed to treat any withdrawal symptoms you experience and licensed clinical counselors will provide therapeutic support to help you manage the psychological symptoms of withdrawal, such as depression, anxiety, and cravings.
  • Residential rehab for alcohol addiction: If your alcohol addiction is severe or you’ve struggled with it for years, a residential addiction treatment program may provide the structure and support you need to get sober for good. Residential alcohol rehab offers individualized care and round-the-clock access to treatment professionals at a licensed facility where you will live for the duration of treatment. Treatment includes evidence-based methods like cognitive behavioral therapy, group counseling, individual and family counseling, 12-Step facilitation, and specialized therapies like music therapy or art therapy. These treatment methods will help you establish a firm foundation of sobriety, gain life skills, learn how to prevent relapse and manage cravings, and give you the tools and peer support you need to stay sober.
  • Intensive outpatient rehab for alcohol addiction: An IOP (intensive outpatient program) offers structured, comprehensive treatment with a more flexible schedule. You’ll attend treatment sessions at an outpatient facility several times a week where you’ll receive a high level of support and structure to help you succeed. Online IOP is another option for those who are unable to attend outpatient rehab in-person or prefer to attend online instead.
  • Sober living programs: Sober living programs provide safe and supportive housing for people in recovery. Residents must commit to avoiding all alcohol and drug use and adhere to the community rules. These homes or apartment units are designed with addiction recovery in mind, providing structured recovery programming, regular drug testing, and peer support services like employment assistance, educational planning, volunteer placement, and more.

Most addiction treatment facilities accept health insurance benefits through providers like Aetna, Cigna, UnitedHealthcare, or Beacon/ValueOptions, and others. If you don’t have insurance, some alternative payment options may include:

If you’re struggling to pay for an alcohol addiction treatment program, you may also qualify for some scholarships or grants offered through some private rehab centers or nonprofit organizations. You can ask the treatment provider or organization directly if they provide this type of assistance.

Ultimately disulfiram may be one aspect of your addiction treatment, but supportive care and comprehensive, individualized treatment will play a big role in helping you stay sober. 

Many Americans suffer from alcohol use disorder and you are not alone. If you’re ready to get help, compassionate and effective treatment is available now.

References:

  1. https://www.webmd.com/mental-health/addiction/features/fighting-alcoholism-with-medications 
  2. https://www.ncbi.nlm.nih.gov/books/NBK64036/
  3. https://www.webmd.com/drugs/2/drug-1446/disulfiram-oral/details
  4. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Disulfiram-(Antabuse) 
https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=601

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