Disulfiram (Antabuse) for Alcohol Use Disorder

Disulfiram (Antabuse) may be FDA-approved for the treatment of alcohol addiction, but the medication can interact poorly with other substances and create health risks.

Disulfiram, also known by its brand name Antabuse, is a prescription medication used to treat chronic alcoholism. According to the National Survey on Drug Use and Health (NSDUH), almost 15 million people aged 12 and older struggle with an alcohol use disorder (AUD) in the United States. 

Treatment is essential in helping to reduce this alarming number, but some approaches may be safer than others. The drug Antabuse is associated with many warnings, interactions and side effects, some of which can be fatal. If you or someone you love is struggling with alcohol abuse and addiction, the safest way to get help is to seek treatment from a licensed rehabilitation center. 

What Is Antabuse (Disulfiram)?

Antabuse is one of three medicines approved by the FDA to treat alcohol dependence. However, because of its interactions and side-effect profile, it is not considered a first-line choice. Unlike naltrexone, a first-line drug that reduces cravings and is used to treat chronic alcoholism, Antabuse creates unwanted symptoms if an individual consumes alcohol while taking this drug. 

It is important to point out that Antabuse is rarely used alone to treat chronic alcoholism. If this drug is chosen, supportive care approaches like behavioral counseling and social support are highly recommended. 

How Does Antabuse Medication Work?

Antabuse is not meant to cure alcoholism; rather, it acts as a deterrent. If alcohol is consumed while an individual is taking this medication, the person will experience sweating, heart palpitations, flushing in the face, nausea and dizziness. 

Disulfiram Mechanism of Action

Disulfiram is a tablet that is taken orally. Upon its digestion in the body, disulfiram blocks an enzyme known as ALDH1A1, which is involved in metabolizing alcohol. When this enzyme is blocked, a substance known as acetaldehyde is increased. This increase in acetaldehyde produces the unpleasant effects that occur when someone drinks alcohol while taking disulfiram.

How Should I Take Antabuse?

Antabuse is only available as tablets that are taken by mouth. The tablets can be swallowed whole, or they can be crushed and mixed with liquids like water, coffee, milk or fruit juice.

Antabuse should never be given to someone who has consumed alcohol within the past 12 hours. In the past, physicians would administer a small quantity of alcohol to a patient while on Antabuse to monitor the effect, but this is no longer done. Rather, the patient should receive detailed and comprehensive education regarding the effects of mixing disulfiram with alcohol. 

Disulfiram Dosage

The dosage of disulfiram ranges between 125 mg and 500 mg. For the first one to two weeks of therapy, the dose is 500 mg once daily. After this time, the dose can be adjusted down to 250 mg or 125 mg once daily.

The maximum daily dose of disulfiram is 500 mg, as dosages beyond this number show no additional benefit. This drug may be used for months or years, depending on the individual and the severity of their AUD. Disulfiram is generally taken in the morning, but patients who experience sleepiness may take the tablet in the evening. 

Disulfiram Side Effects

Disulfiram is associated with many side effects. The most common effects include:

• Headaches
• Sleepiness
• Bad breath or metallic taste

One of the more serious effects that may occur when taking this medication is hepatitis, or inflammation of the liver. Liver failure may develop during the course of therapy with this drug, or it may occur after stopping disulfiram use.

Disulfiram Adverse Effects

There are reports of certain skin, neurological, psychiatric and cardiac events that may occur as a result of taking disulfiram. These events include:

• Skin rash
• Itchiness
• Acne
• Headbanging
• Numbness
• Pounding heartbeats
• Fluttering feeling in chest
• Inability or refusal to speak
• Confusion
• Impaired memory
• Nerve damage

Disulfiram-Like Reactions

Disulfiram-like reactions are adverse effects that can occur from consuming alcohol while using certain medications. These reactions mimic the effects of taking disulfiram together with alcohol. These unpleasant effects include:

• Nausea
• Vomiting
• Stomach pain
• Flushing
• Rapid heartbeat
• Painful headaches
• Slowed respiration
• Cardiovascular collapse
• Abnormal heart rhythms
• Convulsions
• Death

Medications that may trigger this reaction include:

• Metronidazole 
• Bactrim
• Tinidazole
• Chlorpropamide
• Tolbutamide
• Glyburide
• Isosorbide dinitrate
• Nitroglycerin

Disulfiram Interactions

Disulfiram interacts with numerous medications. The drug should never be given with metronidazole or any other medications that can cause a disulfiram-like reaction. Other medicines that interact with disulfiram include:

• Tricyclic antidepressants (amitriptyline)
• Benzodiazepines (diazepam, chlordiazepoxide)
• Theophylline
• Phenytoin (Dilantin)
• Warfarin (Coumadin)
• Rifampin
• Isoniazid

It is important to keep in mind that any medicine that contains alcohol — even if it is a small amount — can cause a disulfiram reaction. This includes cough and cold medicines that come in the form of elixirs and syrups. A doctor or pharmacist should always be consulted before taking any liquid medications to ensure there is no alcohol present. 

Disulfiram Warnings

It is important for patients who are prescribed disulfiram to not consume any alcoholic beverages for a minimum of 12 hours prior to their first dose. When quitting, patients should not consume alcohol until several weeks after stopping the medication. Each patient should be educated about the risks of ingesting certain foods and products that contain alcohol. The FDA has issued a black box warning that disulfiram should never be taken by a person who is intoxicated. In addition, it should never be given to a person without their knowledge. 

Disulfiram use should be avoided in patients with coronary artery disease, heart failure, psychosis or a history of liver disease. Caution is advised if this drug is administered to patients with seizures, diabetes, thyroid disorders, head injuries or kidney disease. Anyone taking this medication should contact their prescriber if they experience jaundice, which is the yellowing of skin or dark urine. Jaundice or its symptoms can be signs of liver toxicity.

How Long Does Antabuse Stay in the System?

Antabuse is absorbed from the digestive tract and metabolized by the liver slowly. The effects can last for up to 14 days after the last dose, so a person should avoid alcohol for at least two weeks after quitting Antabuse. There have been reports of people who consumed alcohol and experienced a disulfiram-alcohol reaction within two weeks after stopping the medication. 

It is important to understand that even small amounts of alcohol, such as the alcohol content found in cooking wine, can cause a disulfiram reaction. The amount of the substance acetaldehyde, which is produced if alcohol is ingested while on Antabuse, can become five to 10 times greater than it would be if alcohol was consumed without Antabuse. Acetaldehyde is the chemical responsible for the nausea, dizziness and other unpleasant effects.

Effectiveness of Antabuse for Alcohol Use Disorder

Various studies have been conducted on the effectiveness of Antabuse for AUD, and the results are mixed. Some studies do show that frequency of drinking days is reduced with Antabuse; however, it has not been proven to improve relapse rates, and adherence to the drug is low. One study had nearly 50% of people stopping the medication and dropping out of the study.

Based on the uncertainty surrounding the drug’s effectiveness and the many serious side effects associated with it, Antabuse might not be the most promising option if you are dealing with alcohol use disorder. Alcohol use disorder is not something that can be treated solely with a pill. It requires a holistic approach that a qualified rehabilitation center can offer.

Quit Drinking With The Recovery Village Cherry Hill

The Recovery Village Cherry Hill at Cooper is an accredited rehabilitation facility that is able to help anyone struggling with alcohol use disorder or alcoholism. Our team of empathetic and highly skilled health care professionals will guide you through a comprehensive program to help you on your road to recovery. 

We are conveniently located in southern New Jersey, just 20 minutes from Philadelphia. Contact us today to learn more about how our treatment services can help you or someone you love recover from alcohol abuse and addiction.