Disulfiram is one of the oldest medications prescribed to treat alcohol use disorder. The Food and Drug Administration (FDA) approved disulfiram in 1951 to help people experiencing problem drinking learn to dislike the effects of alcohol. The medication is an aversion therapy, and it causes uncomfortable side effects when the person taking it consumes an alcoholic beverage.
What Is Disulfiram, and How Is It Prescribed?
There is one major brand name for disulfiram in the United States, Antabuse, which was originally manufactured by Wyeth-Laboratories and is now distributed by Odyssey Pharmaceuticals. Disulfiram is still prescribed to appropriate patients to help them overcome alcohol use disorder, although it was approved over 60 years ago.
To ensure that disulfiram works properly, it is important for the person taking it to have detoxed from alcohol dependence. If the individual has alcohol in their system, or is likely to relapse due to the body’s dependence on the drug, then disulfiram can cause uncomfortable side effects. It is also important for a person who stops taking disulfiram to wait at least two weeks after the prescription is complete before drinking alcohol.
Disulfiram most often comes in tablet form, and it is taken once per day. Unlike other medications, doctors allow their patients to crush disulfiram tablets and mix them with water, juice, milk, coffee, soda, or another nonalcoholic beverage to ingest them more easily if the patient cannot swallow pills.
Tablet doses come in two sizes: 250 mg and 500 mg. The first dose of disulfiram is typically about 250 mg, once per day, for 1-2 weeks. Maintenance doses remain the same; however, if the person does not respond to 250 mg, their doctor can increase the dose to 500 mg per day. If the person experiences problems from a 250 mg dose, their doctor can decrease the medication to 125 mg. People who experience drowsiness that impairs their ability to work should take disulfiram before going to sleep.
Many people take disulfiram regularly; however, the medication can also be used “as needed” to help a person maintain sobriety if they are in a social situation that involves alcohol or pressure to drink. Disulfiram only works if the person knows they are taking the medication because it helps to hold them accountable; if the person has not committed to overcoming alcohol use disorder, “surreptitious” use of this medication will not help the person become sober.
How Disulfiram Works
When a person wants to end their addiction to alcohol, disulfiram helps them avoid relapse by inducing negative side effects when the person drinks. If a person relapses and consumes an alcoholic beverage while taking this medication, disulfiram will block one of the enzymes that helps to metabolize alcohol. This enzyme, aldehyde dehydrogenase (ALDH), is found in both the liver and the brain. When a person consumes alcohol normally, the enzyme oxidizes a byproduct of alcohol, acetaldehyde, into acetic acid. When the enzyme does not oxidize this compound, the amount of acetaldehyde in the blood quickly builds up and can cause negative side effects, which deter the individual from consuming more alcohol. Disulfiram does not prevent alcohol from being eliminated from the body as normal, so the risk of alcohol poisoning does not change.
Within 10 minutes after the person consumes their first drink, they will experience:
- Facial flushing
- Nausea and vomiting
- Chest pain
- Blurred vision
- Difficulty breathing
Unlike other prescription medications, like naltrexone and acamprosate, disulfiram does not reduce cravings, withdrawal symptoms, or compulsions around alcohol. Instead, the symptoms of disulfiram interacting with alcohol are uncomfortable, which teaches the person taking the drug that alcohol is not rewarding.
When combined with psychotherapy, counseling, and rehabilitation, disulfiram can be effective in overcoming an alcohol use disorder. This prescription is only effective in people who have maintained at least one full day of abstinence from alcohol, who are committed to becoming sober, and who understand the consequences that disulfiram induces when they do drink. Disulfiram is especially effective when the person taking it has someone closely monitoring their behavior, such as an AA sponsor or a therapist.
More on Detox
- Substance Abuse Withdrawal Medications
- The Distinction of Going Cold Turkey over Tapering off Drugs
- At-Home vs. Medical Detox
- How to Cope with Withdrawals
- 7 Steps to Weaning Yourself off Drugs
It is possible to overdose on disulfiram. Symptoms of overdose include:
- Loss of coordination
- Loss of consciousness
People who overdose on any substance need immediate medical help. Call 911 to get emergency medical services to help the person immediately.
Fatigue is the most common side effect of disulfiram, so it is important for people taking the medication to avoid heavy machinery or driving for at least the first few weeks of their prescription.
Because disulfiram interacts with liver enzymes, especially when a person consumes an alcoholic beverage, the medication can lead to some side effects. Serious side effects include:
- Allergic reaction
- Serious confusion
- Unusual thoughts or behaviors
- Shallow or reduced breathing
- Weakness in muscles
- Slower heart rate or a weak pulse
- Severe chest pain, especially radiating to the jaw or shoulder
- Upset stomach, nausea, or vomiting that does not go away
- Loss of appetite
- Dark urine
- Jaundice (yellowing of the whites of the eyes or the skin)
- Vision loss
- Eye pain
People who have some medical conditions should consult their doctor before taking disulfiram since the drug can interact with enzymes in the body.
These conditions include:
- Thyroid conditions
- Head trauma, concussions, TBI, or brain injury
- A diagnosed mental health condition
- Heart disease
- Previous history of heart attack or stroke
- High blood pressure
- Kidney disease
- Liver disease
- Allergies to any medications
Additionally, some types of surgery, including dental surgery, could impact how disulfiram affects the body, so it is important to speak to a medical professional before beginning a prescription.
Because disulfiram causes a feeling of chest tightness, some people who have taken the medication can experience cardiovascular problems. However, this is commonly in people who have pre-existing cardiovascular diseases. Disulfiram can exacerbate the problem, but it is not likely to cause a heart condition or stroke that was not already present.
Medical research has not indicated whether or not disulfiram affects fetal development or infants who are breastfeeding. However, women who are breastfeeding, pregnant, or who wish to become pregnant should speak with their doctor about any concerns before beginning their disulfiram prescription.
There are several over-the-counter and prescription medications that may interfere with disulfiram or cause side effects while a person is taking the drug.
These include substances that may have alcohol in them, such as:
- Over-the-counter cough medicine
- Astringents or similar skin products
- Hair dyes
Other drugs that disulfiram can interact with include:
There are many ways to help people who struggle with alcohol use disorder. Several medications, from benzodiazepines to disulfiram, can help a person overcome a physical dependence on alcohol and maintain long-term abstinence. The best procedure for any substance abuse disorder is to get medical supervision for detox and enter a rehabilitation program.
A rehabilitation program can offer some prescription medications, including therapies like disulfiram, that help a person maintain their sobriety. Medication on its own is not enough to overcome an alcohol use disorder; comprehensive therapy is also needed.