Antabuse (Disulfiram): Dosages, Uses, and Side Effects
Author: Thomas Roth
Last Updated: 6/04/2023
Antabuse (Disulfiram) was the first medication to be approved by the FDA for the treatment of alcoholism. Historically, it was often considered to be a “first choice” medication to treat those suffering from alcoholism.
Antabuse works by deterring the consumption of alcohol by creating unpleasant, and sometimes adverse, side effects to alcohol consumption. The effectiveness of this mediation is highly dependent on the patient’s will and commitment to quit drinking and their unwillingness to experience the adverse side effects associated with alcohol consumption while taking this medication.
While dosage may vary based on your response to treatment and the severity of your condition as determined by your doctor, the most commonly prescribed doses of Antabuse are one 250 mg or 500 mg tablet taken by mouth once a day in the morning or evening.
What is Antabuse (Disulfiram)?
Antabuse (Disulfiram) is a medication that is approved for the treatment of alcoholism in adults. It is categorized as an alcohol antagonist (inhibitor) which directly affects the way your body metabolizes alcohol. This medication is intended for use in those who are no longer drinking, as drinking while on this medication has several serious side effects.
Antabuse is not intended to be a cure for alcoholism, but rather a tool for helping patients to maintain sobriety and works best when used in conjunction with other forms of treatment such as counseling.
How Does Antabuse (Disulfiram) Work?
Antabuse is considered to be an alcohol antagonist (inhibitor) which works by blocking the breakdown of alcohol within the body. Antabuse works by binding to an enzyme in the body known as aldehyde dehydrogenase and stopping from effectively metabolizing alcohol, leading to a build-up (toxicity) of acetaldehyde, a byproduct of alcohol.
It is important to note that patients should not begin taking this medication until a minimum of 12 hours has passed since their last drink of alcohol and should continue to abstain from alcohol, in any form, for up to 2 weeks after stopping this medication.
Antabuse does not control cravings for alcohol but rather deters patients from consuming alcohol by creating a negative reaction to consumption. The effectiveness of this medication is heavily dependent on a patient’s unwillingness to experience the unpleasant or adverse side effects associated with consuming alcohol while taking this medication.
Due to this, this medication is generally advised to be given under consistent medical supervision, such as in inpatient treatment facilities during the detox process, where both alcohol consumption and diet can be closely monitored. Additionally, some doctors may recommend that the patient has a family member or loved one help administer them this medication daily to ensure that it is being taken consistently as prescribed.
How to Take Antabuse (Disulfiram)?
Antabuse is taken by mouth, with or without food, once a day as prescribed by your doctor. While some people may find it most effective to take it in the morning, there is a chance that it may cause drowsiness, so it may be more effective to take it in the evening. Consult with your doctor to determine what the most effective schedule is for you. While Antabuse is available in tablet form, it is safe to crush this medication and mix it with liquids (such as water, milk, or juice) if you are unable to take it in tablet form.
The dosage of Antabuse is generally variable, as it is dependent on the severity of the condition being treated and the patient’s reaction to the medication as well as other forms of treatment, such as therapy. However, the most common doses of Antabuse prescribed are one 250 mg or 500 mg tablet that is taken once a day. It is important to note that the maximum recommended dose of Antabuse is 500 mg per day.
While taking this medication, you must avoid all forms of alcohol including those present not only in alcoholic beverages but also in foods or products. Some foods and products that may contain trace amounts of alcohol include cough syrups, mouthwash, aftershave, sauces, and vinegar.
Some drugs to avoid include, but are not limited to, amitriptyline, benznidazole, (blood thinners) some seizure medications (including hydantoins), isoniazid, metronidazole, theophylline, and tinidazole. Please note that this is not a complete list of foods and medications to avoid; if you are unsure if a medication you are currently taking may have negative interactions with Antabuse, make sure to speak to your health care provider to determine the safety of the interaction.
There is a small chance that Antabuse may increase side effects associated with caffeine consumption and, as such, you should avoid consumption of large amounts of caffeine and chocolate.
Consuming alcohol, even small amounts, while taking this medication, will produce unpleasant side effects and possible adverse reactions including flushing, throbbing headaches, breathing problems (such as shortness of breath, shallow breathing, or rapid breathing), nausea, vomiting, dizziness, extreme tiredness, fainting, fast or irregular heartbeat, and blurred vision.
More serious interactions can result in trouble breathing, seizures, loss of consciousness, and chest, jaw, or left arm pain, which may be indicative of more serious medical conditions such as a heart attack. If you or a loved one are experiencing any of these symptoms please contact emergency medical services immediately.
What Are the Uses of Antabuse (Disulfiram)?
Antabuse’s primary approved use is for the treatment of alcoholism and alcohol use disorders. It is currently one of three medications approved to treat alcohol use disorders along with Naltrexone and acamprosate.
Antabuse was the first medication approved for this use. While not as commonly used as it was when first introduced, there are varying opinions on the usefulness of this drug in modern medicine. Some medical professionals still view it as a first-choice medication to help maintain sobriety while others view it as a potential health risk due to the chance of toxicity if alcohol is consumed while taking this medication.
What Are the Side Effects of Antabuse (Disulfiram)
While Antabuse is designed to cause a range of unpleasant side effects to alcohol consumption, there is a chance that you may experience side effects or adverse reactions from the medication itself.
Some of the most common side effects of Antabuse include:
Metallic or garlic taste in the mouth (this side effect is most common as your body becomes used to the medication)
While rare, other possible side effects may include:
- Decreased sexual ability
- Vision changes
- Numbness or tingling of the arms or legs
- Muscle weakness
- Mental or mood changes (such as agitation, depression, and extreme excitement or confusion)
- Liver disease
While allergic reactions are rare, they can be very dangerous. If you experience any of the following please speak to your healthcare provider or contact emergency medical services immediately:
- Swelling of the face, tongue, or throat
- Severe dizziness
- Trouble breathing
Please keep in mind that these are only some of the most commonly seen side effects and reactions associated with this medication, and it is not a comprehensive list. If you experience any abnormal reactions or side effects while taking this medication, consult your healthcare provider to determine whether or not this is a safe treatment plan for you.
How Long Do Antabuse (Disulfiram) Side Effects Last?
In the cases where you consume alcohol while taking Antabuse, the immediate unpleasant side effects may last as little as 30 minutes or as long as several hours; many of these side effects mimic a hangover.
This period is mostly dependent on the amount of alcohol in the system, as Antabuse stops your body from effectively metabolizing the alcohol. Additionally, it is important to keep in mind that these side effects may be present for up to 2 weeks after completion of your course of the medication if any alcohol is consumed during that period.
In regards to side effects caused directly by the medication and not from consumption of alcohol, these side effects should go away within a few weeks as your body adjusts to the medication. If any of the symptoms are bothersome, however, make sure to speak to your health care provider to see if the benefits of this medication outweigh the risks and side effects you may be experiencing, and to make sure that none of your symptoms require medical attention.
What is the Difference Between Antabuse (Disulfiram) and Campral (Acamprosate)?
Antabuse is an alcohol antagonist (inhibitor) which directly affects your body’s ability to metabolize alcohol, resulting in unpleasant side effects. These side effects are intended to act as a deterrent to consuming alcohol. With Antabuse, you are less likely to start drinking again. Any amount of alcohol, even small amounts found in medications or foods, can trigger the side effects of this medication. This medication will not help with cravings.
Campral, on the other hand, works to reduce your cravings for alcohol but is unlikely to result in adverse side effects if you do have alcohol. If you experience a relapse with alcohol while taking Campral you are encouraged to continue taking the medication and to speak to your doctor about the best course of treatment going forwards.
Both medications are seen to be most effective when used alongside other forms of treatment such as therapy and support groups. Neither medication is intended to be a cure for alcoholism, but rather they act as aids to help your sobriety.
One important difference is the frequency at which the medication needs to be taken. While Antabuse is a once-a-day medication, Campral is most commonly prescribed to be taken in regular intervals three times a day, which may make it difficult to remember taking.
What is the Difference Between Antabuse (Disulfiram) and Gabapentin?
Unlike Antabuse and Campral, Gabapentin is not traditionally designed to be prescribed for use in treating alcohol use disorders but has been seen to be effective for this purpose.
Gabapentin, by design, is an anticonvulsant medication. In regards to alcoholism and alcohol use disorders, it is effective in reducing cravings as well as anxiety and stress-related withdrawal symptoms. Gabapentin works by helping to regulate and normalize levels of the neurotransmitter GABA in the brain. There is evidence that Gabapentin helps to regulate and, in some cases, increase mood and sleep for those recovering from alcoholism.
Unlike Antabuse, Gabapentin is not meant to act as a deterrent for alcohol; however, Gabapentin is considered to be a CNS (Central Nervous System) Depressant and, as such, drinking alcohol while on this medication can have a series of adverse or unpleasant side effects such as severe dizziness or drowsiness.
Is Antabuse (Disulfiram) Addictive?
No, Antabuse is not addictive. Additionally, there is no evidence to support that those who stop taking Antabuse suddenly or under the direction of the doctor will experience significant withdrawal symptoms.
Does Antabuse (Disulfiram) Cause Depression?
There is currently no evidence to suggest that Antabuse directly causes depression. It is important to note, however, that there is a strong correlation between depression and comorbid disorders such as alcoholism.
For some people suffering from depression, especially that which is undiagnosed or untreated, there is an increased risk of self-medicating with drugs such as alcohol to avoid the unpleasant thoughts or feelings associated with depression.
So, while Antabuse may not directly cause depression, there is a chance that the feelings and thoughts associated with depression may become more prevalent or the patient may become more aware of them once they have begun their journey with sobriety. This correlation is a significant reason why it is highly recommended that this medication is suggested for used alongside forms of treatment such as counseling.