Disulfiram (Antabuse)

How Does Disulfiram Work?

Disulfiram works by causing severe, hangover-like symptoms when you drink even a small amount of alcohol. Essentially, it stops your liver from breaking down alcohol completely.

The process works like this:

• Normally your liver turns alcohol into acetaldehyde, then acetic acid.
• Acetic acid is harmless, but acetaldehyde is toxic to your body, and plays a role in hangover symptoms.
• Disulfiram stops the metabolism of alcohol at the acetaldehyde stage, allowing it to build up in your system, causing you to feel ill.

If you drink after taking disulfiram, you can end up with five to ten times more acetaldehyde in your body than otherwise. This results in severe, hangover or allergy-like symptoms—including nausea, vertigo, facial flushing, sweating, elevated heart rate, and palpitations. These effects can start almost immediately, and continue until the alcohol has completely left your system.

The Original Medication for Alcoholism

The use of disulfiram for alcohol use disorder was first discovered around the time of World War II. Before that, it was mainly used in rubber factories, and under investigation as a cure for scabies and intestinal parasites. One doctor in Denmark decided to test disulfiram on himself, and realized that it made him sick when he drank alcohol. This confirmed earlier reports from the 1930s, that some rubber factory employees working with the chemical were becoming ill after drinking.

After the war, and more research, disulfiram was introduced as a medication for alcohol addiction, under the name Antabuse (anti-abuse)—the first of its kind.

Antabuse caused a stir when it was introduced, and became widely used in Denmark. The FDA approved it in 1951 for use in the US, and since then it has had a consistent role in alcohol treatment. Antabuse was the only approved medication option for alcohol use disorder until the 1990s.

Disulfiram continues to have a loyal following in Denmark, and remains available in many treatment programs. It is an admittedly harsh way of getting yourself to quit alcohol, but evidence suggests it can still be an effective option for some people.

What Is It Like to Take Antabuse?

Antabuse is a product of its time. When it was first introduced, the medical community had fewer options for treating alcohol addiction, and less understanding of alcohol use disorder as a disease. As a result, this is very much a “tough love” way of getting yourself to quit.

Drinking alcohol when taking Antabuse will make you feel severely ill. You can expect to experience flushed skin, a throbbing headache, neck pain, dizziness, nausea, vomiting, sweating, and shortness of breath, among other issues. The intensity can vary between people, but in some cases the reaction is debilitating. Before the recommended dosage was reduced, some people were hospitalized, and some even died.

Why Take Antabuse/Disulfiram for Alcohol?

Despite its severity, disulfiram is still a useful drug in some cases. If a person is completely committed to abstinence and has already quit drinking, this medication can help reinforce new habits and behaviors. It also remains a strong backup option for people who don’t react well to other medications, or who can’t stop drinking.

How To Take Disulfiram

Because the reaction between alcohol and disulfiram is so severe, many people have trouble staying motivated to take it. As a result, it is best to use disulfiram when you have a support system—such as a rehabilitation program, recovery coach, or a family member who will make sure you take your medication.

Other solutions are available, including a slow-release implant beneath your skin. However, Antabuse is very much a medication for those already committed to quitting.

Cravings & Withdrawal

Disulfiram does not get rid of alcohol cravings, or change a person’s chemical dependency on alcohol. It also does nothing to ease withdrawal symptoms. On the other hand, the medication does not create any dependency of its own. Your body will not develop a tolerance to disulfiram, and its effects generally become stronger, not weaker, over time. The medication begins to have an effect within 30 minutes of taking the pill, and can last up to two weeks in the body.

Extra Precautions

Be sure to wait at least 12 hours after your last drink before beginning to take disulfiram. This medication is best for people who are already past the most severe symptoms of detox, and are ready to begin full abstinence from drinking.

Disulfiram can be a useful emergency medication for a person who needs to quit immediately, but you should always check with your doctor before trying this. This is especially true if you have liver disease, since this medication impacts the liver.

Among the medications to treat AUD, disulfiram is the least safe—especially in those people with liver disease (e.g. liver cirrhosis or elevated liver function tests). Your doctor will likely need to monitor your liver function tests if disulfiram is prescribed.

Other, Non-Desirable Disulfiram Side Effects

Aside from the purposeful, unpleasant interaction between disulfiram and alcohol, side effects can include:

• Headache
• Drowsiness
• Skin rash
• Decreased libido
• Metallic or garlicky taste in mouth

If you’re taking disulfiram, you need to be watchful for alcohol in smaller concentrations—such as in sauces or body care products. Taking Antabuse is similar to having an allergy to alcohol, with the accompanying precautions.

Ironically, considering its rubber factory origins, people with rubber allergies may also have a bad reaction to disulfiram. For a full list of possible drug interactions, speak with your doctor. And overall, we should emphasize that this medication should only be taken under medical supervision.

Is Disulfiram For You?

Disulfiram May Be Helpful If:

• You are pursuing abstinence from alcohol
• You need behavioral reinforcement to stop drinking
• Other medications aren’t working for you
• You are well supervised

Disulfiram May Not Be Best If:

• You drink compulsively
• You aren’t ready to stop drinking completely
• You haven’t stopped drinking yet

Disulfiram is an admittedly “old-school” approach. It is the original of the three FDA-approved medications for alcohol misuse, and has since been followed by naltrexone and acamprosate. Both of these other options are gentler on your system, and may be preferable because they do more than make you physically ill when drinking.

However, if strong negative reinforcement is effective for you, and you have a good support system, disulfiram can still be helpful. It is best to think of it as a tool to combine with other forms of behavioral therapy, after you’ve already committed to changing your behavior. While this is true for all medications for alcoholism, with disulfiram the effects are so severe, and the motivation to continue so low, that you need to be especially confident and well-supported going into it.

If you can accomplish the above, however, this medication can have a powerful effect. If you are willing to stick with it for a long time, it just might help you stay alcohol-free for good.

OTHER MEDICATIONS

Naltrexone | Acamprosate | Gabapentin | Baclofen | Topiramate