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Disulfiram (Antabuse) & Alcoholism Treatment: Uses, Side Effects & Effectiveness

July 6, 2022

Table of Contents

Disulfiram (sold under the brand name Antabuse) is a prescription medication your doctor might use to help you stop drinking alcohol. 

If you take Antabuse and then drink alcohol, you will have what’s called a “disulfiram-like reaction” which can cause you to feel sick, similar to the feeling of a hangover. This helps to deter people from drinking.

Disulfiram is just one of three common Medications for Addiction Treatment (MAT) for alcohol use disorder (AUD). Medication, in combination with behavioral counseling and support, is the best treatment for AUD. 

How Is Disulfiram Used?

You'll need a prescription before beginning Antabuse. Your doctor will tell you how much to take and how often. Those instructions can vary depending on your height, weight, and age.

In general, people take Antabuse pills every day, not just “as needed”. Skip a dose, and you could reduce the effectiveness of therapy and be more tempted to drink.

Disulfiram works by blocking your body's ability to break down alcohol.[1] Typically, when you drink, your body breaks alcohol into metabolites. One of these metabolites is toxic, and it's responsible for the sick feeling you have when you drink too much. Disulfiram causes this toxin to build up, making the individual feel ill/”hungover”, which discourages them from drinking in the future.  Common side effects of drinking while on disulfiram include the following:[2]

  • Anxiety 
  • Blurred vision
  • Chest pain
  • Choking
  • Confusion 
  • Facial flushing
  • Headache
  • Nausea 
  • Sweating
  • Weakness

Most individuals benefit from taking disulfiram for six months or longer until they have been able to really sustain sobriety for an extended period of time.[3] Some people take it for years, particularly if they feel it will help prevent them from relapsing.

Does Disulfiram Work?

Overall, yes, Antabuse is one evidence based method to reduce drinking.[4]

However, Antabuse is really the oldest MAT for AUD currently on the market. Nowadays, newer medications like Naltrexone and Acamprosate are more commonly prescribed for AUD because unlike Antabuse that simply makes you feel sick when you drink, these other medications actually work by reducing cravings to drink, making them more tolerable and potentially more effective than Antabuse.

However, for some individuals who have had good success with Disulfiram (Antabuse) in the past, or who cannot have Naltrexone or Acamprosate for other reasons, Antabuse might be a good choice for AUD.

Antabuse, just like any of the three medications used for AUD, is most effective when coupled with therapy and other forms of behavioral interventions.[4]

Your medications keep you from relapsing while you build life skills. But medication alone can't help you tackle alcohol use disorder. Having good social support, medical support, and behavioral support is also essential for success. 

Known Disulfiram Side Effects 

There are few side effects to Antabuse when taken without using any alcohol.[1] It is concurrent alcohol use that tends to cause the “Disulfiram reaction” that makes people feel ill. Expect to feel sick when you take in alcohol or alcohol-like products while taking Antabuse; this is the way the medication works to prevent misuse of alcohol. 

Who Can Use Antabuse?

Your doctor will look over your medical record and possibly run some blood tests before starting Antabuse. People with these issues should talk to their doctor before starting Antabuse:[5]

  • Heart disease 
  • Psychosis
  • Liver disease

If you think Antabuse or another medication could help you achieve abstinence from alcohol, talk to your doctor about your options.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Disulfiram (Antabuse). National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Disulfiram-(Antabuse). January 2021. Accessed June 2022.
  2. Disulfiram. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a682602.html. August 2017. Accessed June 2022.
  3. Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4907.pdf. 2015. Accessed June 2022.
  4. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64036/. 2009. Accessed June 2022. 
  5. Disulfiram. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459340/. November 2021. Accessed June 2022.

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