Disulfiram, commonly sold under the brand name Antabuse, is a medication used in the treatment of alcohol use disorder and dependency. It must be taken as prescribed and you should always consult with your doctor or healthcare provider before beginning the use of any other medications (prescribed or over the counter) while taking disulfiram, as reactions and adverse effects can occur.

Disulfiram brand names

  • Antabuse
  • Ro-Sulfiram

What is disulfiram prescribed for?

Disulfiram is prescribed for the treatment of alcoholism, referred to in The Diagnostic and Statistical Manual of Mental Disorders (American Psychological Association, 2022) as Alcohol Use Disorder (AUD). This disorder includes classifications of mild, moderate, or severe [1].

Disulfiram is one of three medications that are FDA approved for the treatment of AUD, and is generally prescribed after you have tried other medications or treatments with limited success [2].

Symptoms of AUD include:

  • Being unable to reduce or stop alcohol intake
  • Consistent thoughts of and cravings for alcohol
  • Negative consequences of alcohol use in various areas of life, such as work and relationships
  • Continuing to consume alcohol despite negative impacts on physical or mental health
  • Putting yourself or others at risk due to alcohol consumption, such as driving under the influence
  • Needing to drink increasing amounts of alcohol to produce the same effect
  • Withdrawal symptoms

How does disulfiram work?

Disulfiram works by stopping the body from processing alcohol as usual, which then causes an excess of a toxic compound in the body that will create an unpleasant reaction if you consume alcohol, known as the disulfiram-alcohol reaction [3][4]. This reaction makes you feel unwell, with common symptoms including sickness, headaches, and chest pain, which serve as a deterrent for alcohol consumption.

It is important to note that disulfiram does not cure alcohol addiction, but will help to discourage you from engaging in alcohol use. For this reason, it is advisable to utilize this treatment alongside a talking therapy, in order to receive treatment for the psychological aspects of your addiction as well [3][4].

How is disulfiram usually taken?

Disulfiram is produced in a tablet form - as a 250mg or 500mg tablet. This tablet can be swallowed whole, or if preferable, can be crushed and mixed with water or a soft drink [5].

Your treatment may begin with a 250mg or 500mg prescription, which should be taken orally once per day. While the dose may be increased or decreased, it will not increase to higher than 500mg per day [2][6].

This medication should be taken as prescribed, without missing a dose. If a dose of disulfiram is missed, take the medication as soon as possible, or if it is close to the next dosage time, skip the missed dose. Never take double the prescribed amount in one go, as this can cause adverse reactions.

How long does disulfiram stay in your system?

Disulfiram begins working almost immediately after the first dose and can remain in the body for two weeks after the last dose. For this reason, it is important to abstain from alcohol consumption for at least two weeks following your last dose of this medication, as it will continue to cause a reaction during this time.

Disulfiram side effects

The most common side effects of disulfiram include headaches, fatigue, acne, and a metallic or garlic-like taste. Often, these side effects will go away within a couple of weeks as you continue taking the medication.

Other side effects of disulfiram include:

  • Nausea and vomiting
  • Changes in appetite
  • Muscle pain
  • Chest pain
  • Shortness of breath
  • Changes in vision
  • Increased heartrate
  • Lightheadedness and dizziness
  • Yellowing of skin
  • Dark urine

If you experience any symptoms on this list, or side effects that continue for a long time, consult your doctor to determine whether it is advisable to continue taking the medication [6].

Disulfiram precautions

Before starting this medication, you must have abstained from consuming alcohol for at least 12 hours, so that there is no alcohol in the blood, or you may experience adverse effects [2]. Similarly, you should avoid any medications or foods that contain alcohol while taking this medication.

You should discuss with your doctor any medications (including vitamin supplements) you are currently taking, or may plan to take, as there are various reactions that may occur.

Due to certain side effects of disulfiram and the possibility of a disulfiram-alcohol reaction, it is vital to discuss any health conditions you have with your doctor before commencing this treatment. This is because some conditions can be worsened by taking disulfiram, particularly neurological, psychological, liver, or heart conditions [2][8].

Similarly, there are various psychological effects related to alcohol dependency, so it is advisable to discuss these with your doctor and a mental health professional both before and during this treatment.

If you are pregnant, or plan to get pregnant, you should discuss this with your doctor, as it may not be safe to commence this treatment.

Disulfiram vs alcohol

If you consume any alcohol while taking disulfiram it will cause a disulfiram-alcohol reaction, as this is the purpose of the medication. This reaction will make you feel very unwell, causing symptoms such as sickness, headaches, blurred vision, dizziness, chest pain, and confusion, while in the most severe cases, it can cause serious heart issues and even fatalities [6].

The severity of the reaction will depend on the medication and alcohol levels. For this reason, it is important to abstain from any alcohol consumption while taking this medication, and for at least two weeks after stopping the medication.

Many foods and products also contain alcohol, such as hand-sanitizer, cough syrup, vinegar, some sauces, and some fruits. It is important to be aware that using or consuming any products containing alcohol can also cause this reaction.

It is advisable when using this medication to carry with you a card that states the symptoms of a disulfiram-alcohol reaction, along with the name and number of your next of kin and medical professional, so that medical or psychological intervention can be quickly administered in the case of severe reactions.

Disulfiram interactions

Disulfiram can also cause reactions when combined with various other medications. This includes:

  • some antibiotics: can cause an increase in the side effects of disulfiram
  • blood thinners: can cause excessive blood thinning
  • Metronidazole: can cause confusion or psychosis, so should not be used together [7]

Due to the risks in taking this medication, it should be taken exactly as prescribed, discussed thoroughly with your doctor, and the risks fully understood before you begin this treatment.

It is useful to ensure that your family and friends who act as a support system are also fully aware of these risks, to help in the prevention of adverse outcomes and to know when medical attention is required.

Disulfiram storage

Disulfiram needs to be stored at room temperature, away from excessive heat and moisture. Keep the medicine in its original packaging until taken, so it remains safely enclosed.

As with all medications, it must be stored out of reach of children.

If you have medicine that has expired, or that you no longer require, do not dispose of it in the toilet or bin. Take the medicine to a medical professional so that it may be disposed of appropriately.

What to do if you overdose on disulfiram

If you overdose on disulfiram, you should immediately contact a medical professional and your local Poison Control Center. Generally, an overdose of disulfiram will cause symptoms such as nausea and vomiting, although, in rare cases, it may cause seizures and coma. In severe cases, call 911.

Frequently asked questions about disulfiram

How long will this treatment last?

The length of this treatment will vary depending on the individual, whether you are participating in any other therapy, and how consistently the medication is taken. For the best results from this treatment, you should engage in psychological treatment as well as taking this medication daily, as this can provide support and understanding, and help to prevent relapse [4][9].

Can you drink with disulfiram?

No. You will become very unwell if you consume any alcohol while taking this medication.

Are there any alternatives to disulfiram?

There are two other FDA approved medications to treat alcohol addiction, called acamprosate and naltrexone, that each work slightly differently to disulfiram [8]. Speak to your doctor if you wish to try alternative treatments.

Do not stop taking prescribed medication without first consulting your doctor, as this could cause a relapse, and potentially cause mental and physical health issues.

Resources:

  1. American Psychiatric Association. (March 2022). Substance-Related and Addictive Disorders. In The Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). APA. Retrieved from https://doi.org/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders
  2. Stokes, M., & Abdijadid, S. (January 2022). Disulfiram. Treasure Island, FL: StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK459340/
  3. Crowley, P. (2015). Long-Term Drug Treatment of Patients with Alcohol Dependence.Australian Prescriber. Retrieved from https://doi.org/10.18773/austprescr.2015.015
  4. NAMI: National Alliance on Mental Illness. (n.d.). Mental Health Medications. NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Disulfiram-(Antabuse)
  5. The American Society of Health-System Pharmacists. (n.d.). Disulfiram: MedlinePlus Drug Information. (n.d.). Medline Plus. Retrieved from https://medlineplus.gov/druginfo/meds/a682602.html
  6. RxList. (February 2021). Side Effects of Antabuse (Disulfiram), Warnings, Uses. RxList. Retrieved from https://www.rxlist.com/antabuse-side-effects-drug-center.htm
  7. Center for Substance Abuse Treatment. (2009). Chapter 3: Disulfiram. In Incorporating Alcohol Pharmacotherapies Into Medical Practice. (Treatment Improvement Protocol (TIP) Series, No. 49.) Rockville, MD: Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64036/
  8. National Institute on Alcohol Abuse and Alcoholism. (2014, updated August 2021). Treatment for Alcohol Problems: Finding and Getting Help. NIAAA. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
  9. Mental Health Foundation. (n.d.). Alcohol Dependence. Mental Health Foundation. Retrieved from https://mentalhealthfoundation.org/health-conditions/substance-related-disorders/alcohol-abuse-dependence/