Disulfiram (Antabuse).

Quick Facts: Disulfiram (Antabuse)

Brand Name:  Antabuse
Generic Name: Disulfiram
Drug Class: Aldehyde dehydrogenase inhibitor
FDA-Approved Uses: Alcohol use disorder (AUD)
Common Off-Label Uses: Cocaine dependence, Lyme disease, certain cancers
Typical Adult Dosage: 250 mg daily (maintenance dose)
Black Box Warning: Do not administer to patients while they are intoxicated or without their full knowledge.
Common Side Effects: Metallic taste in mouth, drowsiness, headache, skin rash
Addiction Potential: Low
Pregnancy Category: B — no evidence of risk in animal studies, but human data are limited

What is Disulfiram (Antabuse)?

Disulfiram, marketed under the brand name Antabuse, is a medication used to help people with alcohol use disorder maintain sobriety. It is not a cure for alcoholism, but acts as a deterrent by creating an unpleasant and severe reaction if alcohol is consumed.

Disulfiram works by blocking the enzyme acetaldehyde dehydrogenase, which is responsible for breaking down alcohol in the body. When alcohol is ingested while taking Disulfiram, this enzyme is inhibited, causing a buildup of a toxic substance called acetaldehyde. This buildup leads to the highly uncomfortable symptoms of the disulfiram-alcohol reaction, which can last from 30 minutes to several hours.

FDA-Approved Uses for Disulfiram (Antabuse)

Disulfiram is FDA-approved to treat chronic alcoholism or alcohol use disorder (AUD) as a deterrent to drinking. It is most effective when used as part of a comprehensive treatment plan that includes counseling and psychotherapy.

Common Off-Label Uses of Disulfiram (Antabuse)

Beyond its approved use, Disulfiram is being researched for several off-label applications. These include treating cocaine dependence by affecting dopamine pathways, acting as a potential antibiotic for persistent Lyme disease, and inhibiting tumor growth in various cancers, such as breast and prostate cancer.

Important Black Box Warning for Disulfiram

It is critically important that Disulfiram is never given to a patient while they are intoxicated or without their complete awareness and consent. Both the patient and their family must be fully educated about the severe and potentially fatal consequences of consuming even trace amounts of alcohol while on this medication. The disulfiram-alcohol reaction can be life-threatening.

Disulfiram Side Effects

The most significant side effect of disulfiram is the disulfiram-alcohol reaction, which is the intended deterrent. Symptoms can be severe, and it’s important to communicate with your healthcare provider at the onset of any severe symptoms. Symptoms can include:

• Throbbing headache
• Flushing of the face and upper chest
• Nausea and vomiting
• Chest pain
• Dizziness and weakness
• Blurred vision
• Sweating
• Difficulty breathing and anxiety
• In severe cases, heart problems, seizures, and unconsciousness can occur.

Common Side Effects (without alcohol consumption)

• Metallic or garlic-like taste in the mouth
• Drowsiness or fatigue
• Headache
• Skin rash or acne
• Decreased sexual ability in males

Rare but Serious Side Effects

• Liver damage (hepatotoxicity) can be fatal. Symptoms include dark urine, yellowing of the skin or eyes (jaundice), light-colored stools, and persistent nausea or vomiting.
• Nerve damage (peripheral neuropathy) causes numbness, tingling, pain, or weakness in the hands and feet.
• Psychotic reactions, particularly with high doses.
• Optic neuritis (inflammation of the optic nerve) can cause vision changes or loss.

Disulfiram (Antabuse) Dosage Guidelines

The typical initial dose of Disulfiram is 500 mg, taken once a day for about one to two weeks. After this initial period, the dose is usually reduced to a daily maintenance dose, commonly around 250 mg, but it can range from 125 mg to 500 mg. It can be taken with or without food.

What to Do if You Miss a Dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped entirely. Never double the dose to compensate for a missed one.

Contraindications

Disulfiram is not suitable for everyone. It should not be taken by people who have consumed alcohol within the last 12 hours. It is also contraindicated for those with severe heart disease, coronary artery disease, or a history of psychosis. Additionally, anyone with an allergy to Disulfiram or other thiuram derivatives (often found in certain pesticides or rubber products) should avoid the medication. It is also generally not recommended for pregnant women, breastfeeding, or those planning to become pregnant.

Medication Interactions to Avoid with Disulfiram

Tell your doctor about all medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements. Disulfiram can interact with:

• Alcohol: The most significant and dangerous interaction, causing the disulfiram-alcohol reaction. This includes alcohol in liquid medications, mouthwash, hand sanitizer, and food items.
• Metronidazole (Flagyl): Can cause a psychotic reaction.
• Isoniazid (INH): Can cause coordination and mental changes.
• Warfarin (Coumadin): Disulfiram can increase the blood-thinning effects of Warfarin.

Phenytoin (Dilantin): Disulfiram can increase the levels of this anti-seizure medication in your blood.

Questions to Ask Your Doctor Before Taking Disulfiram (Antabuse)

Before starting treatment, consider asking your doctor whether Disulfiram is the most suitable option for your condition, how long you will need to take it, what the risks of dependence are, whether alternative treatments are available, and how to safely taper off the medication if needed.

• How long after my last drink can I begin this medication?
• What foods, drinks, or personal care products should I strictly avoid because they contain alcohol?
• How long Disulfiram stays in your system

Find Safe & Effective Mental Health Treatment

If you or a loved one is struggling with anxiety, panic attacks, or insomnia, professional help is available.

At Mental Health Rehabs, we connect individuals with psychiatrists, therapists, and treatment centers that offer medication management, psychotherapy, benzodiazepine tapering programs, and more.

Use our treatment locator to find mental health professionals near you.

Frequently Asked Questions About Disulfiram (Antabuse)