Disulfiram for Alcohol Addiction: How It Works Safely

Disulfiram (Antabuse): Treatment for Alcoholism and Alcohol Abuse

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What is Disulfiram?

Doctors use disulfiram (also known by the brand name Antabuse) to treat chronic alcoholism.

Disulfiram can work well for people who want to cut back on their drinking or stop drinking altogether, as a treatment of alcohol use disorder. If a person taking the medication drinks alcohol, they may have many unpleasant and even dangerous side effects. Most effective for people who are committed to their sobriety. Otherwise, a person could simply stop taking the medication if they decide to start drinking alcohol again.

Disulfiram was the first drug approved by the FDA for treating alcohol use disorder in 1951. The most common medication for alcoholism treatment in the 20th century was.

Today, doctors typically replace Antabuse or use it alongside newer drugs like Revia, Vivitrol (naltrexone), and Campral (acamprosate). These newer drugs work differently because they directly interact with brain chemistry.

How Does Disulfiram Work?

Disulfiram is different from newer drugs like Revia, Vivitrol, and Campral. These newer drugs work directly with brain chemistry to treat alcoholism, but disulfiram does not. Instead, it discourages the consumption of alcohol by interfering with the way your body digests and absorbs alcohol. This produces very unpleasant side effects, which make you not want to drink alcohol anymore.

Disulfiram does not treat alcohol withdrawal symptoms or reduce cravings. You should take it regularly by mouth in tablet form (250 mg or 500 mg tablets). People who use disulfiram for alcohol addiction treatment take it once per day.

Disulfiram is not available OTC and must be prescribed by a doctor. A medical doctor will also be able to determine if Antabuse is the right medication for your alcohol dependence treatment, based on your addiction treatment history or if there is a better alternative available.

What Happens If You Drink Alcohol While Taking Disulfiram?

A disulfiram reaction with alcohol can occur if you drink while you’re taking the medication. This reaction will produce very unpleasant or dangerous side effects like:Sweating
Flushing of the upper chest and face
Hyperventilation
Respiratory problems
Bad breath
Blurry vision
Extreme thirst
Throbbing of the head and neck
Nausea
Vomiting
Chest pain/palpitations
Low blood pressure
Fast heart rate
Vertigo
Confusion
Weakness

Other more severe and rare symptoms of a disulfiram reaction with alcohol can include:

Cardiac arrest
Irregular heartbeat
Heart attack
Acute congestive heart failure
Seizures
Unconsciousness
Death

So, how is this disulfiram reaction caused?

Normally, the body breaks down alcohol in two steps: first into acetaldehyde, then into acetic acid. Disulfiram blocks the second step, causing acetaldehyde to build up and trigger unpleasant symptoms. This reaction discourages drinking, though some may avoid it by skipping doses. Even small amounts of alcohol from products like mouthwash, sauces, or vinegar can cause a reaction for up to 14 days after taking disulfiram.

Disulfiram Side Effects

If prescribed disulfiram for alcohol addiction, you may experience side effects. Common ones include fatigue, drowsiness, headache, acne, rash, and a metallic taste. More severe reactions can involve nerve damage, hepatitis, psychosis, or inflammation of the optic nerve. These effects often improve once your doctor reduces the dosage.

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What Are the Symptoms of Disulfiram Withdrawal?

Disulfiram does not produce any known withdrawal symptoms.

How Long Does Disulfiram Stay In Your System?

The half-life of disulfiram is 60 to 120 hours, which is a relatively slow rate of elimination. Most medications can last 12 hours. If you take disulfiram and want to drink heavily again, wait at least two weeks. This allows the medication to leave your system before you drink alcohol.

If you’ve been prescribed disulfiram to treat alcohol use disorder (AUD) or heavy drinking, it’s important to take it daily as directed by your medical care provider. Once you’ve maintained sobriety for a significant period, consult your doctor to discuss whether it’s time to discontinue the medication.

Is Disulfiram Safe to Use?

Disulfiram is safe for treating a medical condition when taken as prescribed by a healthcare professional. However, it may not be suitable for individuals with certain conditions such as schizophrenia, liver or kidney disease, epilepsy, or allergies to sulfur compounds. Before starting outpatient treatment, your doctor will evaluate your health history to ensure it’s a safe option.

Is Antabuse Discontinued?

According to the American Society of Health-System Pharmacists, several pharmaceutical companies have discontinued disulfiram tablets, including:

Teva Pharmaceuticals
Mylan
Rising Pharmaceuticals

Currently, Alvogen is the only supplier of disulfiram tablets.

Disulfiram for Alcohol Addiction Treatment

Disulfiram is not intended to be taken on its own. Instead, it should be used in combination with supportive addiction treatment care and psychotherapy.

Depending on the severity of your addiction and mental health condition, a combination of the following treatment programs may help you overcome your alcohol addiction while you’re taking disulfiram:

Medical detox for alcohol addiction: How to remove disulfiram from body? Medical detox programs provide 24/7 monitoring of your vitals to ensure that you’re safely progressing through alcohol withdrawal. A team of doctors and nurses will administer medication as needed to treat any withdrawal symptoms you experience and licensed clinical counselors will provide therapeutic support to help you manage the psychological symptoms of withdrawal, such as depression, anxiety, and cravings.
Residential rehab for alcohol addiction: If your alcohol addiction is severe or you’ve struggled with it for years, a residential addiction treatment program may provide the structure and support you need to get sober for good. Residential alcohol rehab offers individualized care and round-the-clock access to treatment professionals at a licensed facility where you will live for the duration of treatment. Treatment includes evidence-based methods like cognitive behavioral therapy, group counseling, individual and family counseling, 12-Step facilitation, and specialized therapies like music therapy or art therapy. These treatment methods will help you establish a firm foundation of sobriety, gain life skills, learn how to prevent relapse and manage cravings, and give you the tools and peer support you need to stay sober.
Intensive outpatient rehab for alcohol addiction: An IOP (intensive outpatient program) offers structured, comprehensive treatment with a more flexible schedule. You’ll attend treatment sessions at an outpatient facility several times a week where you’ll receive a high level of support and structure to help you succeed. Online IOP is another option for those who are unable to attend outpatient rehab in-person or prefer to attend online instead.
Sober living programs: Sober living programs provide safe and supportive housing for people in recovery. Residents must commit to avoiding all alcohol and drug use and adhere to the community rules. These homes or apartment units are designed with addiction recovery in mind, providing structured recovery programming, regular drug testing, and peer support services like employment assistance, educational planning, volunteer placement, and more.

Most addiction treatment facilities accept health insurance benefits through providers like Aetna, Cigna, UnitedHealthcare, or Beacon/ValueOptions, and others. If you don’t have insurance, some alternative payment options may include:

Employee Assistance Programs (EAPs)
Third-party healthcare loans
Personal loans from loved ones
Healthcare credit cards

If you or a family member are struggling to pay for an alcohol addiction treatment program, you may also qualify for some scholarships or grants offered through some private rehab centers or nonprofit organizations. You can ask the treatment provider or organization directly if they provide this type of assistance.

Ultimately disulfiram may be one aspect of your substance use disorder treatment, but supportive care and comprehensive, individualized treatment will play a big role in helping you stay sober.

Many Americans are life threatening from alcohol use disorder and you are not alone. If you’re ready to get help, compassionate and effective long term recovery treatment is available now.

Nova Recovery Center offers a large range of substance abuse treatment services: detox, residential, outpatient and sober living.

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