Antabuse (Disulfiram) Treatment for Alcohol Use Disorder

Antabuse (disulfiram) is a medicine used to treat alcohol use disorder. The medication acts as a deterrent because if a person drinks alcohol while taking it, they will get very sick. The unpleasant reaction to alcohol acts as a deterrent that may help someone stop drinking.

This article will cover how Antabuse treats alcohol use disorder, including what happens if you drink on Antabuse.

How Antabuse Works

When you drink alcohol, your body metabolizes it into acetaldehyde. This toxic substance is what causes many of the hangover symptoms that come on after heavy drinking. Usually, your body will break acetaldehyde down into a harmless substance called acetic acid.

Antabuse prevents your body from turning acetaldehyde into acetic acid. As a result, acetaldehyde builds up in your body—up to five to 10 times more than what would be normal after drinking alcohol.

What Happens If You Drink Alcohol While on Antabuse?

When someone drinks alcohol while taking Antabuse, the high level of acetaldehyde in their body triggers a very unpleasant reaction.

Someone who drinks alcohol while taking Antabuse may have mild to severe symptoms, including:

• Flushing
• Nausea
• Copious vomiting
• Sweating
• Thirst
• Throbbing in the head and neck
• Headache
• Respiratory difficulty
• Chest pain
• Palpitations
• Dyspnea (shortness of breath)
• Hyperventilation (rapid breathing)
• Tachycardia (rapid heartbeat)
• Hypotension (low blood pressure)
• Syncope (loss of consciousness)
• Marked uneasiness
• Weakness
• Vertigo
• Blurred vision
• Confusion

Severe reactions from drinking alcohol while on Antabuse include respiratory depression, cardiovascular collapse, myocardial infarction (heart attack), acute congestive heart failure, unconsciousness, arrhythmias, convulsions, and even death.

The severity of the reaction depends on how much Antabuse is in the body and the amount of alcohol that is consumed. The effects of Antabuse start about 10 minutes after alcohol enters the body and can last for an hour or longer. In general, the symptoms will continue as long as alcohol is in the body.

What to Know Before Using Antabuse

If you are taking Antabuse, do not drink any alcoholic beverages, including wine and beer. Specific foods and beverages also need to be avoided while you’re taking Antabuse, including:

• Certain flavorings (such as desserts made with liqueurs or prepared flambe, baking extracts like rum and vanilla)
• Kombucha
• Sauces (for example, meats simmered with wine)
• Vinegar

You also need to avoid any products or medications that may contain alcohol, including:

• Over-the-counter (OTC) cold and flu products such as cough syrup and elixirs
• Personal care items such as hand sanitizers, aftershave, rubbing alcohol, mouthwash, perfume, and hairspray

You can prevent a reaction by not consuming these substances for 12 hours before you take your first dose of Antabuse and for several weeks after you stop taking the drug.

Who Should Not Take Antabuse?

Antabuse is meant for people who are ready to quit drinking and fully understand the consequences of consuming alcohol while they are being treated with the medication.

Antabuse can only be given to someone who is aware and has given their consent for treatment. The drug should never be given to someone who is intoxicated.

Since there is a possibility of serious reactions, you should not take Antabuse if you have severe heart disease, psychosis, or an allergy to Antabuse.

People who are pregnant should not take Antabuse or disulfiram unless their healthcare provider feels that the benefits outweigh the risks.

Disulfiram can interact with other medications, so you should talk to your healthcare provider before using any other prescription or over-the-counter (OTC) drugs or supplements.

How to Use Antabuse

Antabuse is usually taken as a tablet by mouth. The tablets are 200 milligrams each, and you may need to take more than one dose per day.

Your provider will tell you how many tablets to take per day. At the beginning of your treatment, you may take more or less than what you will take as your maintenance dose, depending on your provider's instructions. For example, you may start taking four tablets a day for several weeks, then take just one or even half a tablet to maintain your treatment long-term.

Antabuse can be taken in the morning or evening, but the evening can be better if the medication makes you tired. If you get an upset stomach on disulfiram or Antabuse, try taking it with food. The tablet can also be crushed and added to water, juice, or coffee if this makes it easier to take.

If you miss taking a pill at the regular time, do not double up or take the missed dose close to when the next one is due. Antabuse starts to act quickly after taking your first dose and can continue triggering a response to alcohol for up to two weeks after the medication has been stopped.

If you are taking Antabuse, carry a card with you that describes what will happen if you drink alcohol. The card should have the name and phone number of a healthcare provider to contact in an emergency.

Common Antabuse Side Effects

Even if you do not drink while taking Antabuse, it is still possible to have some side effects from the drug. Some of the most common side effects of Antabuse include:

• Acne
• Drowsiness
• Fatigue
• Headache
• Metallic aftertaste

In rare cases, taking Antabuse can lead to nerve pain or damage, psychosis, and skin rash. A few patients have had an acute liver injury when taking disulfiram. Case studies have also associated disulfiram use with a single seizure episode.

How Effective Is Antabuse?

Research has shown that long-term use of Antabuse is effective at helping people reach and maintain abstinence. The research also showed that the longer a person takes Antabuse, the more effective it is—likely because it helps people develop a habit of not drinking. However, other studies have not shown the same results, and the treatment does not work for everyone.

However, the effectiveness of Antabuse in helping someone to quit drinking depends on how long they continue to take the medication. Since Antabuse or disulfiram is taken as a daily pill, people can easily stop taking the drug and start drinking again several weeks later.

What Antabuse Can’t Do

Antabuse is a physical and psychological deterrent to help stop drinking. The drug does not reduce the person's alcohol cravings and does not treat alcohol withdrawal symptoms.

Coping With Alcohol Cravings While Taking Antabuse

Antabuse is a drinking deterrent, but it won’t prevent you from having alcohol cravings. If you have the urge to drink while you’re on Antabuse, it’s important to reach out for help.

People you can ask for support include:

• Your care team (including the healthcare provider or therapist who prescribed Antabuse for you)
• Your loved ones
• Your Alcoholics Anonymous (AA) sponsor
• Your local support group or online support community

Other places you can turn to for help include:

• The SAMHSA National Helpline, which you can call or text any time (1-800-662-4357).
• The NAMI helpline, which is available from 10 a.m. to 10 p.m. EST, Monday-Friday (1-888-950-6264). You can also text “HelpLine” to 62640 or email helpline@nami.org.
• The Alcoholics Anonymous (AA) website can help you find a local meeting.

If you are looking for reliable online sources of information on how to handle alcohol cravings, check the National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration.